Individual
JADE LYNN HOLLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
532 MAIN ST, SUITE 1, MOOSIC, PA 18507-1001
(570) 471-3569
Mailing address
532 MAIN ST, SUITE 1, MOOSIC, PA 18507-1001
(570) 471-3569
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA054639
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103213688-0001
—
PA
Enumeration date
11/24/2010
Last updated
01/03/2017
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