Provider Demographics
NPI:1043271745
Name:SCHWARTZ, JEAN CANTY (RNCPNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:CANTY
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:RNCPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 PUNCH BOWL DR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2342
Mailing Address - Country:US
Mailing Address - Phone:508-548-9966
Mailing Address - Fax:
Practice Address - Street 1:15 BRAMBLEBUSH PARK
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2325
Practice Address - Country:US
Practice Address - Phone:508-548-6969
Practice Address - Fax:508-540-2793
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA123070363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2818OtherBLUE SHIELD
MANP2818OtherBLUE SHIELD
MASCNP2919Medicare ID - Type UnspecifiedMEDICARE B