MEDICARE: MRS. LUANN B RAU

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	163W00000X	Registered Nurse	327998-1	NY

General Provider Information

NPI Number	:	1710296942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LUANN B RAU

Provider Business Mailing Address
First Line	:	2 JOHNSON RD
Second Line	:
City	:	MONTGOMERY
State	:	NY
Zip	:	12549-2200
Country	:	US
Telephone Number	:	845-713-4773
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 JOHNSON RD
Second Line	:
City	:	MONTGOMERY
State	:	NY
Zip	:	12549-2200
Country	:	US
Telephone Number	:	845-713-4773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	10/05/2010

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