Provider Demographics
NPI:1205048303
Name:JENNINGS, MILAGROS VINA
Entity type:Individual
Prefix:MS
First Name:MILAGROS
Middle Name:VINA
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MILAGROS
Other - Middle Name:VINA
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-1700
Mailing Address - Country:US
Mailing Address - Phone:907-245-1811
Mailing Address - Fax:907-243-4115
Practice Address - Street 1:2900 W 29TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-1700
Practice Address - Country:US
Practice Address - Phone:907-245-1811
Practice Address - Fax:907-243-4115
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK420796310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility