Provider Demographics
NPI:1548926694
Name:CLASSEN, LLORA (NP)
Entity type:Individual
Prefix:
First Name:LLORA
Middle Name:
Last Name:CLASSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 FM 517 RD E
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-8630
Mailing Address - Country:US
Mailing Address - Phone:346-617-8598
Mailing Address - Fax:
Practice Address - Street 1:303 FM 517 RD E
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-8630
Practice Address - Country:US
Practice Address - Phone:346-617-8598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10548443207Q00000X
TX1054843363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine