Provider Demographics
NPI:1891073425
Name:CLASEN, SHANNON NICOL (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:NICOL
Last Name:CLASEN
Suffix:
Gender:
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 NAGLEE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-5309
Mailing Address - Country:US
Mailing Address - Phone:504-913-6897
Mailing Address - Fax:
Practice Address - Street 1:99 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-2917
Practice Address - Country:US
Practice Address - Phone:831-724-7521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011598363LF0000X
LA06530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2162764Medicaid