Provider Demographics
NPI:1184860843
Name:KOLLEH, JANNEH PUSS (LPN)
Entity Type:Individual
Prefix:MISS
First Name:JANNEH
Middle Name:PUSS
Last Name:KOLLEH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 YORKTOWN CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5213
Mailing Address - Country:US
Mailing Address - Phone:302-494-6278
Mailing Address - Fax:
Practice Address - Street 1:10 YORKTOWN CT
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5213
Practice Address - Country:US
Practice Address - Phone:302-494-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0008963164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse