1629721014 NPI number — JAMEE LYNN RAUCH MASTERS OF SCIENCE

Table of content: JAMEE LYNN RAUCH MASTERS OF SCIENCE (NPI 1629721014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629721014 NPI number — JAMEE LYNN RAUCH MASTERS OF SCIENCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAUCH
Provider First Name:
JAMEE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MASTERS OF SCIENCE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629721014
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
698 12TH ST. SE
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-383-1248
Provider Business Mailing Address Fax Number:
503-217-6526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
698 12TH ST. SE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-383-1248
Provider Business Practice Location Address Fax Number:
503-217-6526
Provider Enumeration Date:
01/27/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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