Healthcare Provider Details

I. General information

NPI: 1710978283
Provider Name (Legal Business Name): KATHLEEN F CLASEN C.P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2406 BLUE RIDGE RD SUITE 100
RALEIGH NC
27607-6678
US

IV. Provider business mailing address

2406 BLUE RIDGE RD SUITE 100
RALEIGH NC
27607-6678
US

V. Phone/Fax

Practice location:
  • Phone: 919-786-5001
  • Fax: 919-786-5051
Mailing address:
  • Phone: 919-786-5001
  • Fax: 919-786-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number300322
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: