Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | NP20772 | CA |
NPI | 1003195827 |
---|---|
Provider Name | Stephanie J Rasmussen |
First Address | Alta Loma, CA 91701-4562 |
Second Address | Upland, CA 91786-4920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2011 |
Last Update Date | 10/08/2011 |