Individual
CHRISTINE M JOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8600 75TH ST, SUITE 101, KENOSHA, WI 53142-8200
(262) 652-9430
(262) 652-9433
Mailing address
8600 75TH ST, SUITE 101, KENOSHA, WI 53142-8200
(262) 652-9430
(262) 652-9433
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
41723
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32526900
—
WI
Enumeration date
09/13/2005
Last updated
04/08/2011
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