NPI 1396340741

Jenesis Samuels

Practitioner Driver Fairmont, WV

Practice location

Address: 200 Braddock St, Fairmont, WV 26554-2208
Phone: (304) 534-0538

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X

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Registry record

NPI: 1396340741
Entity type: Individual
Sex (as registered): Male
NPI issued: 3 Dec 2020
Record last updated: 3 Dec 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.