Provider Demographics
NPI:1528819976
Name:JENKINS, DOROTHEA L
Entity type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:L
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 1:1722 N 84TH TER
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2909
Mailing Address - Country:US
Mailing Address - Phone:531-299-2401
Mailing Address - Fax:531-299-2419
Practice Address - Street 1:1722 N 84TH TER
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2909
Practice Address - Country:US
Practice Address - Phone:531-299-2401
Practice Address - Fax:531-299-2419
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE91481163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool