Provider Demographics
NPI:1861260523
Name:LOLIE, JACQUELINE ALISI (RN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ALISI
Last Name:LOLIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9668 MILLIKEN AVE STE 104-243
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6137
Mailing Address - Country:US
Mailing Address - Phone:909-513-6688
Mailing Address - Fax:
Practice Address - Street 1:9668 MILLIKEN AVE STE 104-243
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6137
Practice Address - Country:US
Practice Address - Phone:909-513-6688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95276474163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical