Provider Demographics
NPI:1174030423
Name:JENKINS, ALECIA RENEE (LPN)
Entity Type:Individual
Prefix:
First Name:ALECIA
Middle Name:RENEE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-1071
Mailing Address - Country:US
Mailing Address - Phone:216-258-9394
Mailing Address - Fax:
Practice Address - Street 1:1710 PROSPECT AVE E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2322
Practice Address - Country:US
Practice Address - Phone:216-781-3773
Practice Address - Fax:216-781-2023
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN091051164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty