Provider Demographics
NPI:1780885889
Name:JOLLY, DENISE MARIE (CRNA)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MARIE
Last Name:JOLLY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1330 SERE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-1426
Mailing Address - Country:US
Mailing Address - Phone:504-237-2249
Mailing Address - Fax:404-624-9164
Practice Address - Street 1:1330 SERE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-1426
Practice Address - Country:US
Practice Address - Phone:504-237-2249
Practice Address - Fax:404-624-9164
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN047457367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1686255Medicaid
LA5X068Medicare ID - Type Unspecified