Provider Demographics
NPI:1518118314
Name:RASMUSSEN, JESSICA SUE (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SUE
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:SUE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MAC LANE
Mailing Address - Street 2:AVERA MEDICAL ASSOCIATES CLINIC
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501
Mailing Address - Country:US
Mailing Address - Phone:605-224-5901
Mailing Address - Fax:605-945-5295
Practice Address - Street 1:100 MAC LN
Practice Address - Street 2:AVERA MEDICAL ASSOCIATES CLINIC
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3391
Practice Address - Country:US
Practice Address - Phone:605-224-5901
Practice Address - Fax:605-945-5295
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD8101207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology