Provider Demographics
NPI:1861934515
Name:RASMUSSEN, KATHRYN (PA-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:WELLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30960 STAGECOACH BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7902
Mailing Address - Country:US
Mailing Address - Phone:303-674-6671
Mailing Address - Fax:
Practice Address - Street 1:30960 STAGECOACH BLVD
Practice Address - Street 2:STE 120
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7902
Practice Address - Country:US
Practice Address - Phone:303-674-6671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-12
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004791363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical