Provider Demographics
NPI:1336510304
Name:FAIR, JOLENE AKEMI KEANUENUE
Entity Type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:AKEMI KEANUENUE
Last Name:FAIR
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 1:7367 WETHERSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-5506
Mailing Address - Country:US
Mailing Address - Phone:419-618-6592
Mailing Address - Fax:
Practice Address - Street 1:7367 WETHERSFIELD DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-5506
Practice Address - Country:US
Practice Address - Phone:419-618-6592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory