Basic Information
| Provider Information | |||||||||
| NPI: | 1568971331 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOLLEY | ||||||||
| FirstName: | SUMMER | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MS, RDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 CAMPUS DRIVE | ||||||||
| Address2: | |||||||||
| City: | BRADFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148875591 | ||||||||
| FaxNumber: | 8148875666 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 CAMPUS DRIVE | ||||||||
| Address2: | |||||||||
| City: | BRADFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148875591 | ||||||||
| FaxNumber: | 8148875666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2017 | ||||||||
| LastUpdateDate: | 09/25/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DN004194 | PA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.