Provider Demographics
NPI:1669608931
Name:JENKINS, ROSETTA (RN)
Entity type:Individual
Prefix:MRS
First Name:ROSETTA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 GERARD AVE
Mailing Address - Street 2:MENTAL HEALTH CLINIC
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8001
Mailing Address - Country:US
Mailing Address - Phone:718-960-2883
Mailing Address - Fax:718-960-2948
Practice Address - Street 1:1225 GERARD AVE
Practice Address - Street 2:MENTAL HEALTH CLINIC
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8001
Practice Address - Country:US
Practice Address - Phone:718-960-2883
Practice Address - Fax:718-960-2948
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266955163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult