Provider Demographics
NPI:1730315896
Name:JENKINS, JANDI JO (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JANDI
Middle Name:JO
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 CRYSTAL DR
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-1874
Mailing Address - Country:US
Mailing Address - Phone:815-282-1477
Mailing Address - Fax:815-282-1477
Practice Address - Street 1:908 CRYSTAL DR
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-1874
Practice Address - Country:US
Practice Address - Phone:815-985-9724
Practice Address - Fax:815-282-1477
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.083080164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse