Provider Demographics
NPI:1639771371
Name:JENKINS, MARIA BROOKE
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:BROOKE
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 1:45 BONEHEAD DRIVE
Mailing Address - Street 2:
Mailing Address - City:DELBARTON
Mailing Address - State:WV
Mailing Address - Zip Code:25670
Mailing Address - Country:US
Mailing Address - Phone:304-475-7044
Mailing Address - Fax:
Practice Address - Street 1:45 BONEHEAD DRIVE
Practice Address - Street 2:
Practice Address - City:DELBARTON
Practice Address - State:WV
Practice Address - Zip Code:25670
Practice Address - Country:US
Practice Address - Phone:304-475-7044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant