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General NPI Number Information
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NPI Number | 1669883419
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Entity Type | Individual
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Provider Name | DION CLASEMAN
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Gender | Male
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 24839 161ST AVE
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City | LONG PRAIRIE
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State | MN
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Zip | 56347-4832
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Country | US
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Telephone | 320-732-6245
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Fax | 320-732-6245
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Provider Business Mailing Address
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Address Line | 24839 161ST AVE
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City | LONG PRAIRIE
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State | MN
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Zip | 56347-4832
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Country | US
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Telephone | 320-732-6245
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Fax | 320-732-6245
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 1074542
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License Number State | MN
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