Healthcare Provider Details

I. General information

NPI: 1750212569
Provider Name (Legal Business Name): JORGEN RASMUSSEN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 EAST 100 NORTH
GUNNISON UT
84634
US

IV. Provider business mailing address

PO BOX 759
GUNNISON UT
84634-0759
US

V. Phone/Fax

Practice location:
  • Phone: 435-528-7246
  • Fax:
Mailing address:
  • Phone: 435-528-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12322134-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12322134-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: