Individual
MS. KELLY MARIE RAUSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
1021 BROADWAY ST, BUFFALO, NY 14212-1460
(716) 852-1578
(716) 852-5154
Mailing address
1001 MAIN ST FL 5, BUFFALO, NY 14203-1009
(716) 323-0034
(716) 323-0292
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
441200
NY
363LP0200X
Pediatric Nurse Practitioner
Primary
F381753
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00027206901
UNIVERA
NY
01
—
000560953001
BC/BS
NY
05
—
02665525
—
NY
01
—
050816000026
FIDELIS
NY
01
—
080407000087
FIDELIS
NY
01
—
9512852
IHA
NY
Enumeration date
09/21/2006
Last updated
01/25/2021
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