Basic Information
| Provider Information | |||||||||
| NPI: | 1790275675 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAASSENS | ||||||||
| FirstName: | EVANGELINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BAYUGA | ||||||||
| OtherFirstName: | EVANGELINE | ||||||||
| OtherMiddleName: | AGTARAP | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 736 S ROUTE 4 STE 103 | ||||||||
| Address2: | |||||||||
| City: | SINAJANA | ||||||||
| State: | GU | ||||||||
| PostalCode: | 96910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6719674759 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 736 SOUTH ROUTE 4, SUITE 103 | ||||||||
| Address2: | |||||||||
| City: | SINAJANA | ||||||||
| State: | GU | ||||||||
| PostalCode: | 96910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6716497232 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2018 | ||||||||
| LastUpdateDate: | 06/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | NP0182 | GU | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.