Provider Demographics
NPI:1891917159
Name:JENKINS, GENEVA GAIL
Entity Type:Individual
Prefix:MRS
First Name:GENEVA
Middle Name:GAIL
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PRIVATE DRIVE 411
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-7604
Mailing Address - Country:US
Mailing Address - Phone:740-550-6965
Mailing Address - Fax:
Practice Address - Street 1:TONDA WILLIS
Practice Address - Street 2:1505 LAWRENCE STREET APT E9
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638
Practice Address - Country:US
Practice Address - Phone:740-532-0852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2284773OtherINDPENDENT PROVIDER