MEDICARE: MS. JUDITH C. JOLLETT NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	118609	MA

General Provider Information

NPI Number	:	1346228210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH C. JOLLETT NP

Provider Business Mailing Address
First Line	:	10 CRAB CREEK LN
Second Line	:
City	:	YARMOUTH PORT
State	:	MA
Zip	:	02675-2521
Country	:	US
Telephone Number	:	508-309-1991
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 CEDAR ST
Second Line	:
City	:	HYANNIS
State	:	MA
Zip	:	02601-3009
Country	:	US
Telephone Number	:	508-778-6363
Fax Number	:	508-778-6677

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2006
Last Update Date	:	07/08/2007

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