Provider Demographics
NPI:1649904905
Name:RASMUSSEN, TIANNA L
Entity type:Individual
Prefix:
First Name:TIANNA
Middle Name:L
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 EUSTIS ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1525
Mailing Address - Country:US
Mailing Address - Phone:608-317-8820
Mailing Address - Fax:
Practice Address - Street 1:1355 EUSTIS ST APT 5
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1525
Practice Address - Country:US
Practice Address - Phone:608-317-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0623Medicaid