Provider Demographics
NPI:1881317071
Name:KLAASEN, JENNIFER (RN BSN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KLAASEN
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 S MCCLINTOCK DR STE 302
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5879
Mailing Address - Country:US
Mailing Address - Phone:520-233-7111
Mailing Address - Fax:
Practice Address - Street 1:24101 N TANYA CT
Practice Address - Street 2:
Practice Address - City:MANITO
Practice Address - State:IL
Practice Address - Zip Code:61546-7879
Practice Address - Country:US
Practice Address - Phone:309-241-4515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ267419163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management