Provider Demographics
NPI:1306310859
Name:RASINEN, JAMIE C
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:C
Last Name:RASINEN
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 1:1424 LORA POINT LN
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-3434
Mailing Address - Country:US
Mailing Address - Phone:251-979-2559
Mailing Address - Fax:
Practice Address - Street 1:1424 LORA POINT LN
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-3434
Practice Address - Country:US
Practice Address - Phone:251-979-2559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS12466390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program