Provider Demographics
NPI:1053092577
Name:JENNESS, SARAH LOUISE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LOUISE
Last Name:JENNESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 VALLEY VIEW AVE APT D1
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1809
Mailing Address - Country:US
Mailing Address - Phone:443-826-3009
Mailing Address - Fax:
Practice Address - Street 1:1023 VALLEY VIEW AVE APT D1
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1809
Practice Address - Country:US
Practice Address - Phone:443-826-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program