Provider Demographics
NPI:1093757171
Name:QUEALY, JENSINE BANGSGAARD (CNM, MS)
Entity Type:Individual
Prefix:
First Name:JENSINE
Middle Name:BANGSGAARD
Last Name:QUEALY
Suffix:
Gender:F
Credentials:CNM, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-3137
Mailing Address - Country:US
Mailing Address - Phone:508-222-5200
Mailing Address - Fax:508-236-7290
Practice Address - Street 1:211 PARK ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3143
Practice Address - Country:US
Practice Address - Phone:508-222-5200
Practice Address - Fax:508-236-7290
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA167755367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACN0309OtherBLUE CROSS & BLUE SHIHELD
MA0036813OtherNEIGHBORHOOD HEALTH
MARN0299Medicare ID - Type Unspecified
MACN0309OtherBLUE CROSS & BLUE SHIHELD