Basic Information
| Provider Information | |||||||||
| NPI: | 1790927044 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MD RASMUSSEN, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1954 FT UNION BLVD | ||||||||
| Address2: | STE 108 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841216800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019939564 | ||||||||
| FaxNumber: | 8017335618 | ||||||||
| Practice Location | |||||||||
| Address1: | 3460 PIONEER PKWY | ||||||||
| Address2: | |||||||||
| City: | WEST VALLEY CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841202049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019643100 | ||||||||
| FaxNumber: | 8017335618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2009 | ||||||||
| LastUpdateDate: | 04/01/2009 | ||||||||
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| AuthorizedOfficialLastName: | RASMUSSEN | ||||||||
| AuthorizedOfficialFirstName: | MERWIN | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT /CHAIR PERSON | ||||||||
| AuthorizedOfficialTelephone: | 8014328748 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 211689-4406 | UT | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.