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Individual
ISHMAIL A THOLLEY
Active
Individual
ISHMAIL A THOLLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN282050
PA
251E00000X
Home Health Agency
PN282050
PA
251J00000X
Nursing Care Agency
PN282050
PA
251S00000X
Community/Behavioral Health Agency
PN282050
PA
253Z00000X
In Home Supportive Care Agency
PN282050
PA
Other
Enumeration date
02/28/2012
Last updated
02/29/2012
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