Provider Demographics
NPI:1942322607
Name:RASMUSSEN, ERIK J (CPO)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:J
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 S HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4016
Mailing Address - Country:US
Mailing Address - Phone:336-768-3666
Mailing Address - Fax:336-768-3468
Practice Address - Street 1:1728 S HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4016
Practice Address - Country:US
Practice Address - Phone:336-768-3666
Practice Address - Fax:336-768-3468
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795099Medicaid
NC7702982Medicaid
NC7795099Medicaid