1386738854 NPI number — MS. LISA MARIE RASMUSSEN RC

Table of content: MS. LISA MARIE RASMUSSEN RC (NPI 1386738854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386738854 NPI number — MS. LISA MARIE RASMUSSEN RC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RASMUSSEN
Provider First Name:
LISA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VARNER
Provider Other First Name:
LISA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1386738854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10319 53RD AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYSVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-653-7087
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20903 70TH AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMONDS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-672-3333
Provider Business Practice Location Address Fax Number:
425-712-0539
Provider Enumeration Date:
10/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  RC00041570 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)