Healthcare Provider Details

I. General information

NPI: 1891073425
Provider Name (Legal Business Name): SHANNON NICOL CLASEN MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 AIRPORT BLVD
FREEDOM CA
95019-2917
US

IV. Provider business mailing address

216 NAGLEE AVE
SANTA CRUZ CA
95060-5309
US

V. Phone/Fax

Practice location:
  • Phone: 831-724-7521
  • Fax:
Mailing address:
  • Phone: 504-913-6897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: