Provider Demographics
NPI:1841392529
Name:JENKUSKY, LUCIA MARIE (CNM)
Entity Type:Individual
Prefix:MS
First Name:LUCIA
Middle Name:MARIE
Last Name:JENKUSKY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1002
Mailing Address - Country:US
Mailing Address - Phone:614-645-2700
Mailing Address - Fax:
Practice Address - Street 1:1500 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1002
Practice Address - Country:US
Practice Address - Phone:614-645-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM-10117367A00000X, 367A00000X
NYF000901176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02146909Medicaid
OH2944569Medicaid
NYP65298Medicare UPIN
NYAA1283Medicare ID - Type Unspecified