Provider Demographics
NPI:1760424410
Name:JENKINS, LAURIE A (PA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:FONTAINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:106 ROUTE 118 HWY
Mailing Address - Street 2:
Mailing Address - City:HUGHESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17737-8620
Mailing Address - Country:US
Mailing Address - Phone:949-274-0938
Mailing Address - Fax:
Practice Address - Street 1:106 ROUTE 118 HWY
Practice Address - Street 2:
Practice Address - City:HUGHESVILLE
Practice Address - State:PA
Practice Address - Zip Code:17737-8620
Practice Address - Country:US
Practice Address - Phone:949-274-0938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003294207Q00000X
VA0110003712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine