Provider Demographics
NPI:1750134664
Name:RASMUSSEN, LIEF
Entity type:Individual
Prefix:
First Name:LIEF
Middle Name:
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32387 IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56576-9511
Mailing Address - Country:US
Mailing Address - Phone:701-320-9431
Mailing Address - Fax:
Practice Address - Street 1:2219 PAUL BUNYAN DR NW STE 6-7
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-6188
Practice Address - Country:US
Practice Address - Phone:218-751-2659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MND15092122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program