Provider Demographics
NPI:1649477373
Name:CLANCY, CAROL ANN (RNC MSN ANP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:CLANCY
Suffix:
Gender:F
Credentials:RNC MSN ANP
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:DONOVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LN
Mailing Address - Street 1:60 CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3636
Mailing Address - Country:US
Mailing Address - Phone:781-828-2286
Mailing Address - Fax:
Practice Address - Street 1:720 HARRISON AVE FL 7
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2371
Practice Address - Country:US
Practice Address - Phone:617-414-8261
Practice Address - Fax:617-638-8406
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA181036363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0327565Medicaid
MACLNEP4281Medicare ID - Type Unspecified
P97823Medicare UPIN