Provider Demographics
NPI:1316722796
Name:JOLLES, SANDRA NICOLE (MS, CNS)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:NICOLE
Last Name:JOLLES
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 W ST NW STE A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4815
Mailing Address - Country:US
Mailing Address - Phone:571-888-4055
Mailing Address - Fax:
Practice Address - Street 1:1325 W ST NW STE A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4815
Practice Address - Country:US
Practice Address - Phone:202-232-6936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator