MEDICARE: SEAN RASMUSSEN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	6837840-4405	UT

General Provider Information

NPI Number	:	1629588934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN RASMUSSEN FNP

Provider Business Mailing Address
First Line	:	11272 S RICK CIR
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-4001
Country	:	US
Telephone Number	:	435-890-0209
Fax Number	:

Provider Business Practice Location Address
First Line	:	10011 S CENTENNIAL PKWY STE 350
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-4137
Country	:	US
Telephone Number	:	801-566-5350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	01/09/2024

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