Provider Demographics
NPI:1497266548
Name:PINEDA, JENIE S
Entity Type:Individual
Prefix:
First Name:JENIE
Middle Name:S
Last Name:PINEDA
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 1:3634 CROSSWINDS DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-2797
Mailing Address - Country:US
Mailing Address - Phone:858-842-7423
Mailing Address - Fax:910-491-6959
Practice Address - Street 1:3634 CROSSWINDS DR
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-2797
Practice Address - Country:US
Practice Address - Phone:858-842-7423
Practice Address - Fax:910-491-6959
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2648065376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide