Provider Demographics
NPI:1093975179
Name:JENKINS, MARY H (CNA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:H
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 33RD ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79411-1630
Mailing Address - Country:US
Mailing Address - Phone:806-722-2314
Mailing Address - Fax:
Practice Address - Street 1:2314 33RD ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79411-1630
Practice Address - Country:US
Practice Address - Phone:806-722-2314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging