Healthcare Provider Details

I. General information

NPI: 1285153007
Provider Name (Legal Business Name): PAUL RASMUSSEN RN, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5219 SAINT JOHN DR
ORR MN
55771-8232
US

IV. Provider business mailing address

5219 SAINT JOHN DR
ORR MN
55771-8232
US

V. Phone/Fax

Practice location:
  • Phone: 218-757-3650
  • Fax:
Mailing address:
  • Phone: 218-757-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5415
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: