Provider Demographics
NPI:1558403857
Name:REBECCA JENKINS DO PLC
Entity Type:Organization
Organization Name:REBECCA JENKINS DO PLC
Other - Org Name:NORTH IOWA LASER SKIN SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:641-494-2404
Mailing Address - Street 1:5 N FEDERAL AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-3270
Mailing Address - Country:US
Mailing Address - Phone:641-494-2404
Mailing Address - Fax:
Practice Address - Street 1:5 N FEDERAL AVE STE 104
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-3270
Practice Address - Country:US
Practice Address - Phone:641-494-2404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA54422OtherBLUE CROSS GROUP NUMBER
IA0265223Medicaid
IA0265223Medicaid