Healthcare Provider Details

I. General information

NPI: 1740772235
Provider Name (Legal Business Name): SYDNEY ELIZABETH OWENS RASMUSSEN MMS, MA, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYDNEY ELIZABETH RASMUSSEN PA

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SHADOW MOUNTAIN DR
EL PASO TX
79912-4030
US

IV. Provider business mailing address

1335 GERONIMO DR
EL PASO TX
79925-1836
US

V. Phone/Fax

Practice location:
  • Phone: 915-591-2704
  • Fax: 915-598-3946
Mailing address:
  • Phone: 915-591-2704
  • Fax: 915-598-3946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: