Provider Demographics
NPI:1740385046
Name:RASMUSSEN, DIXIE S (CNM)
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:S
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30180
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0180
Mailing Address - Country:US
Mailing Address - Phone:801-357-7475
Mailing Address - Fax:801-357-7997
Practice Address - Street 1:1000 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1857
Practice Address - Country:US
Practice Address - Phone:435-893-4100
Practice Address - Fax:435-893-0540
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2097604402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife