Provider Demographics
NPI:1629615596
Name:JOLLY, JANIE (LVN)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:
Last Name:JOLLY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 S DANVILLE DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-6414
Mailing Address - Country:US
Mailing Address - Phone:409-659-8846
Mailing Address - Fax:
Practice Address - Street 1:246 CR 801
Practice Address - Street 2:
Practice Address - City:BUNA
Practice Address - State:TX
Practice Address - Zip Code:77612-2025
Practice Address - Country:US
Practice Address - Phone:409-659-8846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX136812164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse