Basic Information
| Provider Information | |||||||||
| NPI: | 1740772235 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RASMUSSEN | ||||||||
| FirstName: | SYDNEY | ||||||||
| MiddleName: | ELIZABETH OWENS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MMS, MA, PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RASMUSSEN | ||||||||
| OtherFirstName: | SYDNEY | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | PA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1335 GERONIMO DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799251836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155912704 | ||||||||
| FaxNumber: | 9155983946 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 SHADOW MOUNTAIN DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799124030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155912704 | ||||||||
| FaxNumber: | 9155983946 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2018 | ||||||||
| LastUpdateDate: | 05/31/2018 | ||||||||
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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 | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.