Provider Demographics
NPI:1992935480
Name:RASMUSSEN, SHELLY M (RN)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:M
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:M
Other - Last Name:VUKOBRAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9700 RAYNE RD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-1865
Mailing Address - Country:US
Mailing Address - Phone:262-501-5777
Mailing Address - Fax:
Practice Address - Street 1:9700 RAYNE RD UNIT 4
Practice Address - Street 2:
Practice Address - City:STURTEVANT
Practice Address - State:WI
Practice Address - Zip Code:53177-1865
Practice Address - Country:US
Practice Address - Phone:262-501-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI165143-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse