Provider Demographics
NPI:1609471093
Name:KOLLIE, JEFFLYN BORYONNOH
Entity Type:Individual
Prefix:
First Name:JEFFLYN
Middle Name:BORYONNOH
Last Name:KOLLIE
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 1:4085 ELAINE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-5603
Mailing Address - Country:US
Mailing Address - Phone:253-331-0595
Mailing Address - Fax:
Practice Address - Street 1:4085 ELAINE CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-5603
Practice Address - Country:US
Practice Address - Phone:253-331-0595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.483512163W00000X, 163WH0200X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide