Provider Demographics
NPI:1063658243
Name:DABOLCYN, JESSICA MAY (STNA)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MAY
Last Name:DABOLCYN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:MAY
Other - Last Name:CODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STNA
Mailing Address - Street 1:153 MALACCA ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-3624
Mailing Address - Country:US
Mailing Address - Phone:330-798-0544
Mailing Address - Fax:
Practice Address - Street 1:153 MALACCA ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305
Practice Address - Country:US
Practice Address - Phone:330-798-0544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide