Provider Demographics
NPI:1184676868
Name:RASMUSSEN, LANDON (PA-C)
Entity Type:Individual
Prefix:
First Name:LANDON
Middle Name:
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 LARIMER PKWY STE 4846
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-9012
Mailing Address - Country:US
Mailing Address - Phone:970-624-2830
Mailing Address - Fax:970-624-2836
Practice Address - Street 1:4840 LARIMER PKWY STE 4846
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-9012
Practice Address - Country:US
Practice Address - Phone:970-624-2830
Practice Address - Fax:970-624-2836
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0002905363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21058075Medicaid
CO21058075Medicaid