1629898945 NPI number — HELEN LOUISE RAU REGISTERED NURSE

Table of content: HELEN LOUISE RAU REGISTERED NURSE (NPI 1629898945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629898945 NPI number — HELEN LOUISE RAU REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAU
Provider First Name:
HELEN
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
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:
1629898945
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
74622A SUNRISE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TWENTYNINE PALMS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92277-3955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-710-1099
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1145 STURGIS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWENTYNINE PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-860-2191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2024

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: 163WC0400X , with the licence number:  567710 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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