Provider Demographics
NPI:1447008412
Name:GINGERICH, RAUSHELL R (RN, ASN)
Entity type:Individual
Prefix:
First Name:RAUSHELL
Middle Name:R
Last Name:GINGERICH
Suffix:
Gender:F
Credentials:RN, ASN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26883 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-9356
Mailing Address - Country:US
Mailing Address - Phone:574-536-6266
Mailing Address - Fax:
Practice Address - Street 1:677 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MI
Practice Address - Zip Code:49032-8524
Practice Address - Country:US
Practice Address - Phone:269-467-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704289288163W00000X
IN28187468A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse