Provider Demographics
NPI:1912045485
Name:JENKINS, REBECCA L (LPN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
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 1:23440 SENEDO RD # B
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-3800
Mailing Address - Country:US
Mailing Address - Phone:540-459-4355
Mailing Address - Fax:
Practice Address - Street 1:209 W CRISER RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2360
Practice Address - Country:US
Practice Address - Phone:540-636-4250
Practice Address - Fax:540-636-7171
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002052846164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse