Provider Demographics
NPI:1326623604
Name:JENKINS, DAWN (STNA)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 ODLIN AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-2742
Mailing Address - Country:US
Mailing Address - Phone:203-501-2201
Mailing Address - Fax:
Practice Address - Street 1:520 ODLIN AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-2742
Practice Address - Country:US
Practice Address - Phone:203-501-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602311690221376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide