Provider Demographics
NPI:1093151748
Name:WINGATE-JENKINS, DEBRA NORINIA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:NORINIA
Last Name:WINGATE-JENKINS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 FAWN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-4204
Mailing Address - Country:US
Mailing Address - Phone:203-389-5561
Mailing Address - Fax:203-389-1169
Practice Address - Street 1:35 FAWN RIDGE DR
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-4204
Practice Address - Country:US
Practice Address - Phone:203-389-5561
Practice Address - Fax:203-389-1169
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005337364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist