Basic Information
| Provider Information | |||||||||
| NPI: | 1003015470 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENKINS | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | PAULINE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 10 TOWNSHIP ROAD 212 SOUTH | ||||||||
| Address2: | |||||||||
| City: | SCOTTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406430848 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10 TOWNSHIP ROAD 212 SOUTH | ||||||||
| Address2: | |||||||||
| City: | SCOTTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406430848 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2007 | ||||||||
| LastUpdateDate: | 07/16/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | PN094239 | OH | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.