Healthcare Provider Details

I. General information

NPI: 1326080615
Provider Name (Legal Business Name): JILL MARIE CONSELINO MSN-RN, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CRAIGWOOD TER
WILBRAHAM MA
01095-1913
US

IV. Provider business mailing address

3 CRAIGWOOD TER
WILBRAHAM MA
01095-1913
US

V. Phone/Fax

Practice location:
  • Phone: 413-949-1232
  • Fax:
Mailing address:
  • Phone: 413-949-1232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number2293928
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1445
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number2293928
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: