Provider Demographics
NPI:1114512472
Name:WHITNEY, JOLICE G
Entity Type:Individual
Prefix:
First Name:JOLICE
Middle Name:G
Last Name:WHITNEY
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 1:348 E PHILADELPHIA AVE # 348
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44507-1716
Mailing Address - Country:US
Mailing Address - Phone:234-232-4283
Mailing Address - Fax:
Practice Address - Street 1:348 E PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507-1716
Practice Address - Country:US
Practice Address - Phone:330-775-6587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide