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General NPI Number Information
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NPI Number | 1548227879
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Entity Type | Individual
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Provider Name | JILL M JOLLEY PAC
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Gender | Female
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Dates
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Enumeration Date | 04/28/2006
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 1900 RIDGE RD
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City | WEST SENECA
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State | NY
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Zip | 14224-3332
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Country | US
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Telephone | 716-712-0670
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Fax | 716-712-0674
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Provider Business Mailing Address
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Address Line | 1900 RIDGE RD
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City | WEST SENECA
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State | NY
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Zip | 14224-3332
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Country | US
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Telephone | 716-712-0670
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Fax | 716-716-0674
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA052482
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 010802
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License Number State | NY
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