Provider Demographics
NPI:1083258008
Name:JENKINS, DAWYN MARIE
Entity Type:Individual
Prefix:
First Name:DAWYN
Middle Name:MARIE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 TODD ST
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1108
Mailing Address - Country:US
Mailing Address - Phone:708-646-8059
Mailing Address - Fax:
Practice Address - Street 1:402 TOWN CENTER RD
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2300
Practice Address - Country:US
Practice Address - Phone:708-852-5179
Practice Address - Fax:708-481-2010
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.001815363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily