Provider Demographics
NPI:1790231215
Name:JENKINS, FAITH MARIE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:FAITH
Middle Name:MARIE
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 1:4180 HUTCHINSON RIVER PKWY E
Mailing Address - Street 2:APT. 16F BLDG 32A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4802
Mailing Address - Country:US
Mailing Address - Phone:718-483-6478
Mailing Address - Fax:
Practice Address - Street 1:4180 HUTCHINSON RIVER PKWY E
Practice Address - Street 2:APT. 16F BLDG 32A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4802
Practice Address - Country:US
Practice Address - Phone:718-483-6478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235137-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse