Most Relevant Information
Provider Data
| NPI Number: | 1003412149 |
| Provider Name: | LORI JENKINS |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/04/2020 |
| Last Updated: | 12/04/2020 |
Provider Practice Location
1100 9TH ST STE D
VIENNA
WV
261052176
Practice Location Phone/Fax
| Phone: | 3044286148 |
| Fax: |
Provider Mailing Location
1409 11TH AVE
VIENNA
WV
261051065
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |