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General NPI Number Information
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NPI Number | 1053057166
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Entity Type | Individual
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Provider Name | JOLENE PREVITY
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Gender | Female
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Dates
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Enumeration Date | 05/11/2022
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 552 N PARK AVENUE WARREN
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City | WARREN
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State | OH
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Zip | 44481
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Country | US
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Telephone | 234-243-3127
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Fax | 330-306-9373
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Provider Business Mailing Address
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Address Line | 1378 MERCER GROVE CITY RD
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City | MERCER
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State | PA
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Zip | 16137-6244
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Country | US
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Telephone | 724-301-2710
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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