Healthcare Provider Details

I. General information

NPI: 1629554449
Provider Name (Legal Business Name): AMY RASMUSSEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2018
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11269 JEFFERSON HWY N FL 1
CHAMPLIN MN
55316-3123
US

IV. Provider business mailing address

13839 254TH AVE NW
ZIMMERMAN MN
55398-9029
US

V. Phone/Fax

Practice location:
  • Phone: 651-503-1994
  • Fax:
Mailing address:
  • Phone: 651-503-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5959
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: