Provider Demographics
NPI:1053057166
Name:PREVITY, JOLENE
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:PREVITY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1378 MERCER GROVE CITY RD
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:PA
Mailing Address - Zip Code:16137-6244
Mailing Address - Country:US
Mailing Address - Phone:724-301-2710
Mailing Address - Fax:
Practice Address - Street 1:552 N PARK AVENUE
Practice Address - Street 2:WARREN
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481
Practice Address - Country:US
Practice Address - Phone:234-243-3127
Practice Address - Fax:330-306-9373
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator