Provider Demographics
NPI:1003015470
Name:JENKINS, PATRICIA PAULINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:PAULINE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TOWNSHIP ROAD 212 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SCOTTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45678
Mailing Address - Country:US
Mailing Address - Phone:740-643-0848
Mailing Address - Fax:
Practice Address - Street 1:10 TOWNSHIP ROAD 212 SOUTH
Practice Address - Street 2:
Practice Address - City:SCOTTOWN
Practice Address - State:OH
Practice Address - Zip Code:45678
Practice Address - Country:US
Practice Address - Phone:740-643-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN094239164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse