Provider Demographics
NPI:1033260252
Name:DENSMORE, AGNES GERALYN (CNM)
Entity Type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:GERALYN
Last Name:DENSMORE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1657
Mailing Address - Country:US
Mailing Address - Phone:781-871-2822
Mailing Address - Fax:781-871-3996
Practice Address - Street 1:2100 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1657
Practice Address - Country:US
Practice Address - Phone:781-871-2822
Practice Address - Fax:781-871-3996
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA199200176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife