Provider Demographics
NPI:1215029970
Name:CASS, JEAN S (FNP)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:S
Last Name:CASS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301C US ROUTE ONE
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:96 CAMPUS DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-885-9905
Practice Address - Fax:207-396-5600
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0020832363LF0000X
MECNP121029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1971Medicaid
VT08V991OtherMVP
VT4653001OtherVERMONTH MANAGED CAREAPEX
VT8000335OtherLADIES FIRST
VT500007135OtherTRAVELERS MEDICARE
VT00048194OtherBCBS
VTVN1971Medicare PIN
VT00048194OtherBCBS
VT8000335OtherLADIES FIRST
VTS77870Medicare UPIN