Provider Demographics
NPI:1700297918
Name:RASMUSSEN, DIANA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 HARRISON ST
Mailing Address - Street 2:SOUTHERN NEW YORK NEUROSURGICAL GROUP, P.C.
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2120
Mailing Address - Country:US
Mailing Address - Phone:607-729-4942
Mailing Address - Fax:607-729-7516
Practice Address - Street 1:46 HARRISON ST
Practice Address - Street 2:SOUTHERN NEW YORK NEUROSURGICAL GROUP, P.C.
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2120
Practice Address - Country:US
Practice Address - Phone:607-729-4942
Practice Address - Fax:607-729-7516
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338475363LF0000X
PASP013837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily