Provider Demographics
NPI:1114384138
Name:RAU, TENNILLE (NP)
Entity type:Individual
Prefix:
First Name:TENNILLE
Middle Name:
Last Name:RAU
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81073-1011
Mailing Address - Country:US
Mailing Address - Phone:719-691-4488
Mailing Address - Fax:833-450-2207
Practice Address - Street 1:172 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:CO
Practice Address - Zip Code:81073-1011
Practice Address - Country:US
Practice Address - Phone:719-691-4488
Practice Address - Fax:833-450-2207
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992173363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
0992173OtherLICENSE
CO22730061Medicaid
COMM3777527OtherDEA