Basic Information
| Provider Information | |||||||||
| NPI: | 1093757171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUEALY | ||||||||
| FirstName: | JENSINE | ||||||||
| MiddleName: | BANGSGAARD | ||||||||
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| Credential: | CNM, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 PARK ST | ||||||||
| Address2: | |||||||||
| City: | ATTLEBORO | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027033137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082225200 | ||||||||
| FaxNumber: | 5082367290 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 PARK ST | ||||||||
| Address2: | |||||||||
| City: | ATTLEBORO | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027033143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082225200 | ||||||||
| FaxNumber: | 5082367290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 11/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 167755 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | CN0309 | 01 | MA | BLUE CROSS & BLUE SHIHELD | OTHER | 0036813 | 01 | MA | NEIGHBORHOOD HEALTH | OTHER |