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General NPI Number Information
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NPI Number | 1770985343
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Entity Type | Individual
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Provider Name | RANDY JOSEPH RAU DNP, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 6876 W PHELPS RD
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City | MANTON
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State | MI
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Zip | 49663-9056
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Country | US
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Telephone | 147-968-0086
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Fax |
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Provider Business Mailing Address
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Address Line | 26 SW DEYO LANDING LOOP
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City | CACHE
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State | OK
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Zip | 73527-3278
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Country | US
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Telephone | 810-922-3592
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704410533
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License Number State | MI
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