Most Relevant Information
Provider Data
| NPI Number: | 1003417882 |
| Provider Name: | MARJENNA MOORE |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/06/2020 |
| Last Updated: | 11/06/2020 |
Provider Practice Location
1408 HARRISON AVE
ELKINS
WV
262413325
Practice Location Phone/Fax
| Phone: | 3046364390 |
| Fax: |
Provider Mailing Location
RT 1 BOX 62
BEVERLY
WV
26253
Provider Mailing Phone/Fax
| Phone: | 3046147644 |
| Fax: |