MEDICARE: KATIE J RASMUSSEN PA-C

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	363A00000X	Physician Assistant	2142	MN
2	363A00000X	Physician Assistant	5234-023	WI

General Provider Information

NPI Number	:	1659780229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE J RASMUSSEN PA-C

Provider Business Mailing Address
First Line	:	3301 W FOREST HOME AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-2843
Country	:	US
Telephone Number	:	414-389-2131
Fax Number	:

Provider Business Practice Location Address
First Line	:	3611 S CHICAGO AVE
Second Line	:
City	:	SOUTH MILWAUKEE
State	:	WI
Zip	:	53172-3738
Country	:	US
Telephone Number	:	414-762-7270
Fax Number	:

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

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	12/07/2021

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Directions to “ KATIE J RASMUSSEN PA-C” Practice Location

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