Provider Demographics
NPI:1760587174
Name:JOLLY, JENNA (NP)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:
Last Name:JOLLY
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Gender:F
Credentials:NP
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Mailing Address - Street 1:260 NEW LUDLOW RD
Mailing Address - Street 2:WESTERN MASS PHYSICIAN ASSOCIATES INC
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020
Mailing Address - Country:US
Mailing Address - Phone:413-533-3470
Mailing Address - Fax:413-533-6859
Practice Address - Street 1:2 HOSPITAL DR
Practice Address - Street 2:SUITE 101 DBA HOLYOKE ASSOCIATES IN INTERNAL MEDICINE
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040
Practice Address - Country:US
Practice Address - Phone:413-536-6902
Practice Address - Fax:413-532-9871
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA251899363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0704172Medicaid
MANP5191Medicare ID - Type Unspecified
MA0704172Medicaid