Healthcare Provider Details

I. General information

NPI: 1790275675
Provider Name (Legal Business Name): EVANGELINE CLAASSENS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVANGELINE AGTARAP BAYUGA

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 SOUTH ROUTE 4, SUITE 103
SINAJANA GU
96910
US

IV. Provider business mailing address

736 S ROUTE 4 STE 103
SINAJANA GU
96910
US

V. Phone/Fax

Practice location:
  • Phone: 671-649-7232
  • Fax:
Mailing address:
  • Phone: 671-967-4759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP0182
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: