MEDICARE: MRS. JEAN S CLANCY ANP, RN, MSN

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	363LA2200X	Adult Health Nurse Practitioner	413194	CA

General Provider Information

NPI Number	:	1053660332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEAN S CLANCY ANP, RN, MSN

Provider Business Mailing Address
First Line	:	3101 CALLE CEDRO
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-2782
Country	:	US
Telephone Number	:	805-569-5219
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 CALLE CEDRO
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-2782
Country	:	US
Telephone Number	:	805-569-5219
Fax Number	:

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

Provider Enumeration Date	:	09/02/2012
Last Update Date	:	09/02/2012

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