MEDICARE: MRS. JOLENE AKEMI KEANUENUE FAIR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RM2200X	Medical Laboratory Technician

General Provider Information

NPI Number	:	1336510304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOLENE AKEMI KEANUENUE FAIR

Provider Business Mailing Address
First Line	:	7367 WETHERSFIELD DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-5506
Country	:	US
Telephone Number	:	419-618-6592
Fax Number	:

Provider Business Practice Location Address
First Line	:	7367 WETHERSFIELD DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-5506
Country	:	US
Telephone Number	:	419-618-6592
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2015
Last Update Date	:	10/15/2015

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