Provider Demographics
NPI:1528883394
Name:ROSE, JEANNIE JENKINS
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:JENKINS
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:ELIZABETH
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:306 BEECHWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-4705
Mailing Address - Country:US
Mailing Address - Phone:919-724-3641
Mailing Address - Fax:
Practice Address - Street 1:306 BEECHWOOD TRL
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4705
Practice Address - Country:US
Practice Address - Phone:919-724-3641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95397526163W00000X
NY946806163W00000X
NC258060163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse