Provider Demographics
NPI:1508144742
Name:DUROSINMI, JENNIFER AMANDA (CNA/CMT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:AMANDA
Last Name:DUROSINMI
Suffix:
Gender:F
Credentials:CNA/CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 PENTLAND DR
Mailing Address - Street 2:APT.# B
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-7230
Mailing Address - Country:US
Mailing Address - Phone:443-635-4143
Mailing Address - Fax:
Practice Address - Street 1:2211 PENTLAND DR
Practice Address - Street 2:APT.# B
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-7230
Practice Address - Country:US
Practice Address - Phone:443-635-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA001143753747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant