Provider Demographics
NPI:1508890559
Name:JOLLEY, SANDRA N (ARNP, PHD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:N
Last Name:JOLLEY
Suffix:
Gender:F
Credentials:ARNP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24366
Mailing Address - Street 2:M/S 359107
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0366
Mailing Address - Country:US
Mailing Address - Phone:206-598-8920
Mailing Address - Fax:206-598-7663
Practice Address - Street 1:4245 ROOSEVELT WAY NE
Practice Address - Street 2:CAMPUS BOX 354780
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6920
Practice Address - Country:US
Practice Address - Phone:206-598-3000
Practice Address - Fax:206-598-3040
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00072137163W00000X
WAAP30000385363L00000X, 363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9605239Medicaid
WAAB21410Medicare PIN
WAP31033Medicare UPIN