Provider Demographics
NPI:1528286192
Name:PRAUSA, GAYLEEN RACHELE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:GAYLEEN
Middle Name:RACHELE
Last Name:PRAUSA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:GAYLEEN
Other - Middle Name:RACHELE
Other - Last Name:BEDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:550 W HIGHWAY 105
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9122
Mailing Address - Country:US
Mailing Address - Phone:719-488-9860
Mailing Address - Fax:719-488-9868
Practice Address - Street 1:550 W HIGHWAY 105
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9122
Practice Address - Country:US
Practice Address - Phone:719-488-9860
Practice Address - Fax:719-488-9868
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical