Provider Demographics
NPI:1073281432
Name:RASMUSSEN, ELIZABETH MOORE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MOORE
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1214 VAUGHN RD # 2800
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2863
Mailing Address - Country:US
Mailing Address - Phone:336-506-5840
Mailing Address - Fax:
Practice Address - Street 1:1214 VAUGHN RD # 2800
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2863
Practice Address - Country:US
Practice Address - Phone:336-506-5840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC0010-11625363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program