Provider Demographics
NPI:1417000118
Name:RASMUSSEN, DONALD R (ARNP)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 RAINIER BLVD N
Mailing Address - Street 2:#240
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2807
Mailing Address - Country:US
Mailing Address - Phone:425-392-8842
Mailing Address - Fax:425-392-8841
Practice Address - Street 1:455 RAINIER BLVD N
Practice Address - Street 2:#240
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2807
Practice Address - Country:US
Practice Address - Phone:425-392-8842
Practice Address - Fax:425-392-8841
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005925363LP0808X
WARN00126135163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9633454Medicaid
WAGAB32292Medicare PIN
WA9633454Medicaid