Provider Demographics
NPI:1215029277
Name:JENKINS, ELIZABETH CHERITA (NP)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:CHERITA
Last Name:JENKINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4534 WEST OUTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1210
Mailing Address - Country:US
Mailing Address - Phone:248-798-6753
Mailing Address - Fax:
Practice Address - Street 1:18101 OAKWOOD BLVD
Practice Address - Street 2:INTERIM STAY UNIT
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48123-4089
Practice Address - Country:US
Practice Address - Phone:313-982-5770
Practice Address - Fax:313-982-5771
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704163024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily