Provider Demographics
NPI:1689347296
Name:JENKINS, ANGELA DENNISE (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DENNISE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5113 BACK STRETCH BLVD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2964
Mailing Address - Country:US
Mailing Address - Phone:240-461-9308
Mailing Address - Fax:
Practice Address - Street 1:5113 BACK STRETCH BLVD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-2964
Practice Address - Country:US
Practice Address - Phone:240-461-9308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR126130163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant