Provider Demographics
NPI:1649691817
Name:DUCASSE, JEAN C
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:C
Last Name:DUCASSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 COBURN ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-1741
Mailing Address - Country:US
Mailing Address - Phone:781-595-5802
Mailing Address - Fax:
Practice Address - Street 1:39 COBURN ST.
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902
Practice Address - Country:US
Practice Address - Phone:781-595-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN68201164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse