Provider Demographics
NPI:1407022619
Name:TEVNAN, JANE (NP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:TEVNAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:TEVNAN
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:171 MAIN ST STE 203B
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1187
Mailing Address - Country:US
Mailing Address - Phone:508-881-3029
Mailing Address - Fax:508-881-1752
Practice Address - Street 1:730 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-1612
Practice Address - Country:US
Practice Address - Phone:508-376-2515
Practice Address - Fax:508-376-9932
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA181950363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110081232AMedicaid