MEDICARE: JESSICA RAUSCH F.N.P.

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	363LF0000X	Family Nurse Practitioner	4704276478	MI

General Provider Information

NPI Number	:	1730563339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RAUSCH F.N.P.

Provider Business Mailing Address
First Line	:	4518 JAMES DR
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48642-3782
Country	:	US
Telephone Number	:	989-859-2150
Fax Number	:

Provider Business Practice Location Address
First Line	:	3016 W WACKERLY ST
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48640-6960
Country	:	US
Telephone Number	:	989-631-6730
Fax Number	:

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

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	07/13/2015

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