Provider Demographics
NPI:1538468517
Name:CLAASEN, JOHANNA A (PA)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:A
Last Name:CLAASEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1410 ROLKIN CT
Mailing Address - Street 2:STE 101
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-3587
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:434-654-7752
Practice Address - Street 1:1410 ROLKIN CT
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3587
Practice Address - Country:US
Practice Address - Phone:434-293-9149
Practice Address - Fax:434-293-9140
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2016-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110003520363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVC081CMedicare PIN