Provider Demographics
NPI:1043847916
Name:RASMUSSEN, NICHOLAS (HIS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11052 HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-3740
Mailing Address - Country:US
Mailing Address - Phone:515-278-2517
Mailing Address - Fax:
Practice Address - Street 1:11052 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-3740
Practice Address - Country:US
Practice Address - Phone:515-278-2517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082209237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist