Healthcare Provider Details

I. General information

NPI: 1184676868
Provider Name (Legal Business Name): LANDON RASMUSSEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 LARIMER PKWY STE 4846
JOHNSTOWN CO
80534-9012
US

IV. Provider business mailing address

4840 LARIMER PKWY STE 4846
JOHNSTOWN CO
80534-9012
US

V. Phone/Fax

Practice location:
  • Phone: 970-624-2830
  • Fax: 970-624-2836
Mailing address:
  • Phone: 970-624-2830
  • Fax: 970-624-2836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0002905
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0002905
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: