Healthcare Provider Details

I. General information

NPI: 1245397637
Provider Name (Legal Business Name): CAROL F RASMUSSEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W 300 N
ROOSEVELT UT
84066-2336
US

IV. Provider business mailing address

210 W 300 N
ROOSEVELT UT
84066-2336
US

V. Phone/Fax

Practice location:
  • Phone: 435-722-6163
  • Fax: 435-722-9291
Mailing address:
  • Phone: 435-722-6163
  • Fax: 435-722-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number268377-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number208377-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: