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General NPI Number Information
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NPI Number | 1982703674
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Entity Type | Individual
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Provider Name | KELLY MARIE RAUSCH PNP
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Gender | Female
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 1021 BROADWAY ST
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City | BUFFALO
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State | NY
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Zip | 14212-1460
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Country | US
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Telephone | 716-852-1578
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Fax | 716-852-5154
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Provider Business Mailing Address
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Address Line | 1001 MAIN ST FL 5
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City | BUFFALO
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State | NY
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Zip | 14203-1009
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Country | US
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Telephone | 716-323-0034
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Fax | 716-323-0292
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 441200
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | F381753
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License Number State | NY
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