Provider Demographics
NPI:1578908331
Name:FOLLEY, JESSIKA MARILYN (LPN)
Entity Type:Individual
Prefix:
First Name:JESSIKA
Middle Name:MARILYN
Last Name:FOLLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JESSIKA
Other - Middle Name:M
Other - Last Name:FOLLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:264 S LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 909
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3302
Mailing Address - Country:US
Mailing Address - Phone:716-449-6291
Mailing Address - Fax:
Practice Address - Street 1:1976 SHERIDAN DR
Practice Address - Street 2:APT 8
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14223-1226
Practice Address - Country:US
Practice Address - Phone:716-449-6291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
OH401301760911376K00000X
NY343175281011R376K00000X
OHPN.152897-M-IV164W00000X
NY315941164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide