Provider Demographics
NPI:1417203910
Name:JENKINS, CASSANDRA LEE (RN)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:LEE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W GREEN TREE RD
Mailing Address - Street 2:#301
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2955
Mailing Address - Country:US
Mailing Address - Phone:414-446-5895
Mailing Address - Fax:
Practice Address - Street 1:1600 W GREEN TREE RD
Practice Address - Street 2:#301
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-2955
Practice Address - Country:US
Practice Address - Phone:414-446-5895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86722-30163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management