Provider Demographics
NPI:1255026068
Name:JOLLY, DANNITA FRANCINE
Entity type:Individual
Prefix:
First Name:DANNITA
Middle Name:FRANCINE
Last Name:JOLLY
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 1:2622 SHADYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-3449
Mailing Address - Country:US
Mailing Address - Phone:304-531-5153
Mailing Address - Fax:
Practice Address - Street 1:2622 SHADYSIDE RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-3449
Practice Address - Country:US
Practice Address - Phone:304-531-5153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant