Individual
JERRY RENESIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2111 WOODLAND RD SE, ROANOKE, VA 24014-4641
(757) 285-7710
Mailing address
2111 WOODLAND RD SE, ROANOKE, VA 24014-4641
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/18/2025
Last updated
04/23/2025
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