Provider Demographics
NPI:1639361892
Name:CASSON, DEBORAH R (NP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:R
Last Name:CASSON
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 1:260 MERRIMAC ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2192
Mailing Address - Country:US
Mailing Address - Phone:978-499-7400
Mailing Address - Fax:978-499-7488
Practice Address - Street 1:260 MERRIMAC ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2192
Practice Address - Country:US
Practice Address - Phone:978-499-7400
Practice Address - Fax:978-499-7488
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP9456OtherBLUE CROSS
MANP9456OtherBLUE CROSS