Provider Demographics
NPI:1073929196
Name:JELKS, LAKISHA (CERTIFIED NURSE ASST)
Entity Type:Individual
Prefix:
First Name:LAKISHA
Middle Name:
Last Name:JELKS
Suffix:
Gender:F
Credentials:CERTIFIED NURSE ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19904 LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60411-1435
Mailing Address - Country:US
Mailing Address - Phone:708-965-9758
Mailing Address - Fax:
Practice Address - Street 1:19904 LAKEWOOD AVE
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60411-1435
Practice Address - Country:US
Practice Address - Phone:708-965-9758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide