MEDICARE: MRS. JEAN A ANSCOMBE RNCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	111418	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1031020	OTHER	MA	BEACON AND NHP
2	454937	OTHER	MA	TUFTS
3	7992321	OTHER	MA	CIGNA
4	079031	OTHER	MA	VALUE OPTIONS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	PN0034	OTHER	MA	BC BS

General Provider Information

NPI Number	:	1790833184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEAN A ANSCOMBE RNCS

Provider Business Mailing Address
First Line	:	31 EASTERN POINT RD
Second Line	:
City	:	GLOUCESTER
State	:	MA
Zip	:	01930-4134
Country	:	US
Telephone Number	:	978-559-0001
Fax Number	:	978-559-0003

Provider Business Practice Location Address
First Line	:	85 EASTERN AVE STE 302
Second Line	:
City	:	GLOUCESTER
State	:	MA
Zip	:	01930-1869
Country	:	US
Telephone Number	:	978-559-0001
Fax Number	:	978-559-0003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/09/2007

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