Provider Demographics
NPI:1023433976
Name:JOLLEY, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:JOLLEY
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:HC 89 BOX 8190
Mailing Address - Street 2:
Mailing Address - City:TALKEETNA
Mailing Address - State:AK
Mailing Address - Zip Code:99676-9701
Mailing Address - Country:US
Mailing Address - Phone:907-733-9208
Mailing Address - Fax:
Practice Address - Street 1:34300 TALKEETNA SPUR ROAD
Practice Address - Street 2:
Practice Address - City:TALKEETNA
Practice Address - State:AK
Practice Address - Zip Code:99676-9701
Practice Address - Country:US
Practice Address - Phone:907-733-9208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK19437163W00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse