Provider Demographics
NPI:1053089995
Name:JENKINS, JUSTINE (RN)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 W SHOAL CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-6918
Mailing Address - Country:US
Mailing Address - Phone:425-420-6522
Mailing Address - Fax:
Practice Address - Street 1:1116 W SHOAL CREEK LN
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-6918
Practice Address - Country:US
Practice Address - Phone:425-420-6522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-04
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN213864163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical