Provider Demographics
NPI:1790275675
Name:CLAASSENS, EVANGELINE (NP)
Entity Type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:
Last Name:CLAASSENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EVANGELINE
Other - Middle Name:AGTARAP
Other - Last Name:BAYUGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:736 S ROUTE 4 STE 103
Mailing Address - Street 2:
Mailing Address - City:SINAJANA
Mailing Address - State:GU
Mailing Address - Zip Code:96910
Mailing Address - Country:US
Mailing Address - Phone:671-967-4759
Mailing Address - Fax:
Practice Address - Street 1:736 SOUTH ROUTE 4, SUITE 103
Practice Address - Street 2:
Practice Address - City:SINAJANA
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-649-7232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUNP0182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily