Provider Demographics
NPI:1386324820
Name:RAUSE, NICOLAS WILLIAM (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:WILLIAM
Last Name:RAUSE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:522 W NEWTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2890
Mailing Address - Country:US
Mailing Address - Phone:724-853-8922
Mailing Address - Fax:724-853-8925
Practice Address - Street 1:522 W NEWTON ST STE 100
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2890
Practice Address - Country:US
Practice Address - Phone:724-853-8922
Practice Address - Fax:724-853-8925
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOA006524363A00000X
PAMA064635363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant