Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD2020-0574 | NM |
Y | 208600000X | Surgeon | MD2020-0574 | NM |
NPI | 1003201427 |
---|---|
Provider Name | Jessica Mae Rasmussen |
First Address | La Crosse, WI 54601-5429 |
Second Address | La Crosse, WI 54601-5429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2015 |
Last Update Date | 21/07/2020 |