MEDICARE: RACHEL E FRUTH NP

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	363L00000X	Nurse Practitioner	NP08392	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	P00319302	OTHER	RRMC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000379337	OTHER	ANTHEM

General Provider Information

NPI Number	:	1992788343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL E FRUTH NP

Provider Business Mailing Address
First Line	:	PO BOX 378
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44871-0378
Country	:	US
Telephone Number	:	419-609-1112
Fax Number	:	419-609-1123

Provider Business Practice Location Address
First Line	:	2815 S STATE ROUTE 100
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-8974
Country	:	US
Telephone Number	:	419-448-9728
Fax Number	:	419-448-4531

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	02/25/2015

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