Provider Demographics
NPI:1225066038
Name:JENRETTE, ASA CLARENCE JR (RRT, MBA)
Entity Type:Individual
Prefix:MR
First Name:ASA
Middle Name:CLARENCE
Last Name:JENRETTE
Suffix:JR
Gender:M
Credentials:RRT, MBA
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Mailing Address - Street 1:5 BLACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-6003
Mailing Address - Country:US
Mailing Address - Phone:757-722-9961
Mailing Address - Fax:757-728-3187
Practice Address - Street 1:5 BLACKBERRY LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-6003
Practice Address - Country:US
Practice Address - Phone:757-722-9961
Practice Address - Fax:757-728-3187
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0117002863227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered