Provider Demographics
NPI:1841607041
Name:LACASSE, JENNIFER ANN (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANN
Last Name:LACASSE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 POST OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1290
Mailing Address - Country:US
Mailing Address - Phone:413-598-7770
Mailing Address - Fax:413-599-1399
Practice Address - Street 1:70 POST OFFICE PARK
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1290
Practice Address - Country:US
Practice Address - Phone:413-598-7770
Practice Address - Fax:413-599-1399
Is Sole Proprietor?:No
Enumeration Date:2014-07-20
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN229501363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400182192Medicare PIN