Provider Demographics
NPI:1629835566
Name:JENKINS, ANITA R
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:R
Last Name:JENKINS
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 1:870 E ROUTE 130 APT N5
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-2818
Mailing Address - Country:US
Mailing Address - Phone:856-524-0991
Mailing Address - Fax:
Practice Address - Street 1:134 VINE ST
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-2446
Practice Address - Country:US
Practice Address - Phone:856-524-0991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services