Provider Demographics
NPI:1326080615
Name:CONSELINO, JILL MARIE (MSN-RN, ATC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:CONSELINO
Suffix:
Gender:F
Credentials:MSN-RN, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CRAIGWOOD TER
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1913
Mailing Address - Country:US
Mailing Address - Phone:413-949-1232
Mailing Address - Fax:
Practice Address - Street 1:3 CRAIGWOOD TER
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1913
Practice Address - Country:US
Practice Address - Phone:413-949-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2293928163WC0400X, 163WC1500X
MA14452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer