Basic Information
| Provider Information | |||||||||
| NPI: | 1194758102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RASMUSSEN | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FREUND | ||||||||
| OtherFirstName: | PATRICIA | ||||||||
| OtherMiddleName: | IONE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 460 5TH STREET N | ||||||||
| Address2: | DASSEL CLINIC | ||||||||
| City: | DASSEL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202753358 | ||||||||
| FaxNumber: | 3206933290 | ||||||||
| Practice Location | |||||||||
| Address1: | 460 5TH STREET N | ||||||||
| Address2: | |||||||||
| City: | DASSEL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202753358 | ||||||||
| FaxNumber: | 3206933290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 39855 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 444726300 | 05 | MN | MEDICAID |