Healthcare Provider Details

I. General information

NPI: 1538468517
Provider Name (Legal Business Name): JOHANNA A. CLAASEN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 ROLKIN CT SUITE 101
CHARLOTTESVILLE VA
22911-3587
US

IV. Provider business mailing address

1410 ROLKIN CT STE 101
CHARLOTTESVILLE VA
22911-3587
US

V. Phone/Fax

Practice location:
  • Phone: 434-293-9149
  • Fax: 434-293-9140
Mailing address:
  • Phone: 434-654-7794
  • Fax: 434-654-7752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110003520
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: