Provider Demographics
NPI:1073935557
Name:JENKINS, SADIE ANN (RN, PW, CM)
Entity Type:Individual
Prefix:MRS
First Name:SADIE
Middle Name:ANN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:RN, PW, CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 FORD AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:MN
Mailing Address - Zip Code:55336-1371
Mailing Address - Country:US
Mailing Address - Phone:320-864-3185
Mailing Address - Fax:320-864-1484
Practice Address - Street 1:1805 FORD AVE N STE 200
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:MN
Practice Address - Zip Code:55336-1371
Practice Address - Country:US
Practice Address - Phone:320-864-3185
Practice Address - Fax:320-864-1484
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 156967-6163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management