Provider Demographics
NPI:1659665826
Name:JENKINS, JUDITH ELAINE
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ELAINE
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 1:9975 PLAINVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1311
Mailing Address - Country:US
Mailing Address - Phone:313-303-9930
Mailing Address - Fax:
Practice Address - Street 1:9975 PLAINVIEW AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1311
Practice Address - Country:US
Practice Address - Phone:313-303-9930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist