Provider Demographics
NPI:1316345440
Name:RAUCH, BRYAN W (NP-C, MSN)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:W
Last Name:RAUCH
Suffix:
Gender:M
Credentials:NP-C, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25950 DIXIE HWY STE 400
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2983
Mailing Address - Country:US
Mailing Address - Phone:567-585-0010
Mailing Address - Fax:567-225-3490
Practice Address - Street 1:25950 DIXIE HWY STE 400
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2983
Practice Address - Country:US
Practice Address - Phone:567-585-0010
Practice Address - Fax:567-225-3490
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16719-NP363LC0200X
OHAPRN.CNP.16719363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0115148Medicaid
OHH421832Medicare PIN