Provider Demographics
NPI:1316378409
Name:JENKINS, GINA MARIA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIA
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 1:625 N EUCLID AVE STE 551
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1687
Mailing Address - Country:US
Mailing Address - Phone:314-802-8080
Mailing Address - Fax:314-802-8082
Practice Address - Street 1:625 N EUCLID AVE STE 551
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1687
Practice Address - Country:US
Practice Address - Phone:314-802-8080
Practice Address - Fax:314-802-8082
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide