Provider Demographics
NPI:1417163759
Name:RASMUSSEN, LYDIA DOLORES (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:DOLORES
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E VETERANS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311
Mailing Address - Country:US
Mailing Address - Phone:760-252-6200
Mailing Address - Fax:760-252-6248
Practice Address - Street 1:100 E VETERANS PARKWAY
Practice Address - Street 2:VETERANS HOME OF CA BARSTOW
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311
Practice Address - Country:US
Practice Address - Phone:760-252-6200
Practice Address - Fax:760-252-6248
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342833363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA342833OtherBRN
CANP6180OtherBRN