Provider Demographics
NPI:1700851573
Name:JOLLETT, MARY JO (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARY JO
Middle Name:
Last Name:JOLLETT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:UNIT B
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3127
Practice Address - Country:US
Practice Address - Phone:508-775-5011
Practice Address - Fax:508-775-4574
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA122505367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA0748OtherBLUE CROSS OF MA
MANA0748Medicare ID - Type Unspecified