Provider Demographics
NPI:1891720710
Name:CLAASSEN, SHIRLEY ANN (MD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANN
Last Name:CLAASSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:NE
Mailing Address - Zip Code:68719-0107
Mailing Address - Country:US
Mailing Address - Phone:402-569-3060
Mailing Address - Fax:
Practice Address - Street 1:401 S FIFTH ST
Practice Address - Street 2:
Practice Address - City:LYNCH
Practice Address - State:NE
Practice Address - Zip Code:68746-3013
Practice Address - Country:US
Practice Address - Phone:402-569-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10454208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE092712OtherMEDICARE
SD5900050Medicaid
NE47048743401Medicaid
NE092712OtherMEDICARE
NE47048743401Medicaid