Basic Information
| Provider Information | |||||||||
| NPI: | 1710087838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JELLINEK | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 905 | ||||||||
| Address2: | |||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085488989 | ||||||||
| FaxNumber: | 5085485789 | ||||||||
| Practice Location | |||||||||
| Address1: | 449 ROUTE 130 | ||||||||
| Address2: | |||||||||
| City: | SANDWICH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088889241 | ||||||||
| FaxNumber: | 5088889243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 163W00000X | 92186 | MA | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 256251 | 01 | MA | MAGELLAN | OTHER | 727622 | 01 | MA | TUFTS HEALTH | OTHER |