Provider Demographics
NPI:1548234529
Name:RASMUSSEN, HOLLY (PA-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:RASMUSSEN
Suffix:
Gender:F
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 1:3225 BLUE RIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8060
Mailing Address - Country:US
Mailing Address - Phone:919-781-1050
Mailing Address - Fax:503-244-5963
Practice Address - Street 1:3225 BLUE RIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8060
Practice Address - Country:US
Practice Address - Phone:919-781-1050
Practice Address - Fax:503-244-5963
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA 00886363AM0700X
NC0010-10372363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR550423Medicare UPIN
ORR119547Medicare ID - Type Unspecified