MEDICARE: SHRAUCHLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1396249629	OTHER	AR	NPI

General Provider Information

NPI Number	:	1659086171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHRAUCHLE

Provider Business Mailing Address
First Line	:	1671 FOXBORO CT
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72713-9369
Country	:	US
Telephone Number	:	417-861-2053
Fax Number	:

Provider Business Practice Location Address
First Line	:	3733 N BUSINESS DR # 3721
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-5203
Country	:	US
Telephone Number	:	479-443-5476
Fax Number	:

Authorized Official
Title or Position	:	CRNA
Name	:	MRS. SANDY LEIGH HAMMON-RAUCHLE
Credential	:
Telephone Number	:	417-861-2053

Provider Enumeration Date	:	01/18/2023
Last Update Date	:	01/18/2023

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Directions to “SHRAUCHLE ” Practice Location

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