Provider Demographics
NPI:1205116506
Name:RASMUSSEN, NICHOLAS K (MD)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:K
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W FORT ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4501
Mailing Address - Country:US
Mailing Address - Phone:208-422-1000
Mailing Address - Fax:
Practice Address - Street 1:156 N 6TH STREET
Practice Address - Street 2:
Practice Address - City:BASIN
Practice Address - State:WY
Practice Address - Zip Code:82410-0388
Practice Address - Country:US
Practice Address - Phone:307-568-2499
Practice Address - Fax:307-568-2699
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMRM-1905207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY527OtherBOARD OF MEDICINE
IDMRM-1905OtherSTATE BOARD OF MEDICINE