Provider Demographics
NPI:1124306295
Name:RASMUSSEN, AUSTIN HEATH (PA-C)
Entity type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:HEATH
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 PINE ST
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-1755
Mailing Address - Country:US
Mailing Address - Phone:208-934-8390
Mailing Address - Fax:
Practice Address - Street 1:637 PINE ST
Practice Address - Street 2:
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330-1755
Practice Address - Country:US
Practice Address - Phone:208-934-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
WA60236691207P00000X
IDPA-1045363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine