Provider Demographics
NPI:1790833184
Name:ANSCOMBE, JEAN A (RNCS)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:A
Last Name:ANSCOMBE
Suffix:
Gender:F
Credentials:RNCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 EASTERN POINT RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4134
Mailing Address - Country:US
Mailing Address - Phone:978-559-0001
Mailing Address - Fax:978-559-0003
Practice Address - Street 1:85 EASTERN AVE STE 302
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-1869
Practice Address - Country:US
Practice Address - Phone:978-559-0001
Practice Address - Fax:978-559-0003
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111418364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1031020OtherBEACON AND NHP
MA454937OtherTUFTS
MA7992321OtherCIGNA
MA079031OtherVALUE OPTIONS
MA1891677Medicaid
MAPN0034OtherBC BS
MANS0410Medicare ID - Type UnspecifiedPROVIDER ID NUMBER