Healthcare Provider Details

I. General information

NPI: 1417572249
Provider Name (Legal Business Name): STEPHANIE ALEXIS RASMUSSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 E 19TH AVE
AURORA CO
80045-2507
US

IV. Provider business mailing address

12700 E 19TH AVE
AURORA CO
80045-2507
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-9287
  • Fax:
Mailing address:
  • Phone: 303-724-9287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number325600
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: