Healthcare Provider Details

I. General information

NPI: 1316103591
Provider Name (Legal Business Name): JENNIFER LEIGH RASMUSSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W MAIN ST # 27
PANDORA OH
45877-5203
US

IV. Provider business mailing address

PO BOX 27
PANDORA OH
45877-0027
US

V. Phone/Fax

Practice location:
  • Phone: 567-208-1128
  • Fax:
Mailing address:
  • Phone: 567-208-1128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704346653
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28235770A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.362460
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: