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General NPI Number Information
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NPI Number | 1780578666
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Entity Type | Individual
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Provider Name | IAN MICHAEL JOLLEY
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Gender | Male
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 911 CASTELLO AVE
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City | FAIRPLAY
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State | CO
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Zip | 80440-5094
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Country | US
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Telephone | 719-836-2055
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Fax |
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Provider Business Mailing Address
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Address Line | 341 PANTHER CT
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City | WOODLAND PARK
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State | CO
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Zip | 80863-9031
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Country | US
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Telephone | 269-932-8594
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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 | 146L00000X
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Taxonomy Name | Paramedic
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License Number | 029078
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License Number State | CO
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