Individual
JENNIFER JILL MOMEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11 CHENOWETH DRIVE, SUITE A, BRIDGEPORT, WV 26330
(303) 842-5777
(304) 842-3318
Mailing address
PO BOX 390, 11 CHENOWETH DRIVE, BRIDGEPORT, WV 26330
(304) 842-5777
(304) 842-3318
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
WV18808
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0110704000
—
WV
Enumeration date
08/29/2006
Last updated
07/08/2007
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