Healthcare Provider Details

I. General information

NPI: 1851116206
Provider Name (Legal Business Name): HEATHER MARIE RASMUSSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 E 10185 S
SANDY UT
84070-4338
US

IV. Provider business mailing address

399 E 10185 S
SANDY UT
84070-4338
US

V. Phone/Fax

Practice location:
  • Phone: 385-542-1813
  • Fax:
Mailing address:
  • Phone: 385-542-1813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number5298584-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: