Provider Demographics
NPI:1164799052
Name:POLLOCK, JOETTA AHLEEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOETTA
Middle Name:AHLEEN
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7755 ROUTE 83
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTON
Mailing Address - State:NY
Mailing Address - Zip Code:14138-9633
Mailing Address - Country:US
Mailing Address - Phone:716-988-3291
Mailing Address - Fax:
Practice Address - Street 1:7755 ROUTE 83
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTON
Practice Address - State:NY
Practice Address - Zip Code:14138-9633
Practice Address - Country:US
Practice Address - Phone:716-988-3291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY425546-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool