Provider Demographics
NPI:1962102624
Name:CASSELL, JENNIFER RENEE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENEE
Last Name:CASSELL
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 1:124 CLARA HEIGHTS LOOP
Mailing Address - Street 2:
Mailing Address - City:DANESE
Mailing Address - State:WV
Mailing Address - Zip Code:25831-7180
Mailing Address - Country:US
Mailing Address - Phone:304-731-6403
Mailing Address - Fax:
Practice Address - Street 1:124 CLARA HEIGHTS LOOP
Practice Address - Street 2:
Practice Address - City:DANESE
Practice Address - State:WV
Practice Address - Zip Code:25831-7180
Practice Address - Country:US
Practice Address - Phone:304-731-6403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant