Basic Information
| Provider Information | |||||||||
| NPI: | 1154772382 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RASMUSSEN | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRM | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16756 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972920756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9713863433 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10209 SE DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972661372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9713863433 | ||||||||
| FaxNumber: | 5032082596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2016 | ||||||||
| LastUpdateDate: | 06/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | 15-CRM-172 | OR | Y |
No ID Information.