Provider Demographics
NPI:1508586868
Name:SEMIEN, MICHAEL DWAYNE JR
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DWAYNE
Last Name:SEMIEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-0727
Mailing Address - Country:US
Mailing Address - Phone:304-636-4747
Mailing Address - Fax:304-636-7724
Practice Address - Street 1:#1 5TH STREET
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241
Practice Address - Country:US
Practice Address - Phone:304-636-4747
Practice Address - Fax:304-636-7724
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant