Provider Demographics
NPI:1174587182
Name:RASMUSSEN, CHAD DONALD (APRN)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:DONALD
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 8TH AVE W
Mailing Address - Street 2:
Mailing Address - City:CRESCO
Mailing Address - State:IA
Mailing Address - Zip Code:52136-1064
Mailing Address - Country:US
Mailing Address - Phone:563-547-2022
Mailing Address - Fax:
Practice Address - Street 1:321 8TH AVE W
Practice Address - Street 2:
Practice Address - City:CRESCO
Practice Address - State:IA
Practice Address - Zip Code:52136-1064
Practice Address - Country:US
Practice Address - Phone:563-547-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 2000363L00000X
IAA103966363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN955112000Medicaid
MN500004096Medicare PIN
MN955112000Medicaid
279044Medicare ID - Type Unspecified
Q45764Medicare UPIN