Basic Information
| Provider Information | |||||||||
| NPI: | 1003195827 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RASMUSSEN | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6782 TIGER EYE PL | ||||||||
| Address2: | |||||||||
| City: | ALTA LOMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917014562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093673923 | ||||||||
| FaxNumber: | 9099414282 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 SAN BERNARDINO RD | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917864920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099852811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2011 | ||||||||
| LastUpdateDate: | 08/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NP20772 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.