Healthcare Provider Details

I. General information

NPI: 1043725658
Provider Name (Legal Business Name): DORENE JELLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAPLE ST
HOLYOKE MA
01040-5144
US

IV. Provider business mailing address

21 TOLEDO AVE
WESTFIELD MA
01085-4453
US

V. Phone/Fax

Practice location:
  • Phone: 413-420-2200
  • Fax: 413-534-5416
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN155093
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: