Provider Demographics
NPI:1487286084
Name:CLASSEN, CLIFFORD G
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:G
Last Name:CLASSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11214 47TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-9664
Mailing Address - Country:US
Mailing Address - Phone:425-231-7003
Mailing Address - Fax:
Practice Address - Street 1:11214 47TH AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-9664
Practice Address - Country:US
Practice Address - Phone:425-231-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide