Provider Demographics
NPI:1801330154
Name:THOLE, JESTER (LPN)
Entity type:Individual
Prefix:MISS
First Name:JESTER
Middle Name:
Last Name:THOLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CHELSEA RIDGE DR
Mailing Address - Street 2:APT C
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-5635
Mailing Address - Country:US
Mailing Address - Phone:845-476-0260
Mailing Address - Fax:
Practice Address - Street 1:22 CHELSEA RIDGE DR
Practice Address - Street 2:APT C
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-5635
Practice Address - Country:US
Practice Address - Phone:845-476-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320753-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse