Provider Demographics
NPI:1083059620
Name:JENKINS, VENA M (PRACTICAL NURSE)
Entity Type:Individual
Prefix:
First Name:VENA
Middle Name:M
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PRACTICAL NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21240 VAN BUREN ST
Mailing Address - Street 2:#1
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-5977
Mailing Address - Country:US
Mailing Address - Phone:248-352-0201
Mailing Address - Fax:
Practice Address - Street 1:21240 VAN BUREN ST
Practice Address - Street 2:#1
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-5977
Practice Address - Country:US
Practice Address - Phone:248-352-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703080389164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse