Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1053934620 |
---|---|
Provider Name | Jennifer Hensley |
First Address | Charleston, WV 25309-1311 |
Second Address | Charleston, WV 25309-1311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2020 |
Last Update Date | 18/05/2020 |