Provider Demographics
NPI:1538408489
Name:JENKINS, WENDY J (RN)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:J
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 1:7456 E HUNTINGTON DR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4061
Mailing Address - Country:US
Mailing Address - Phone:330-774-7448
Mailing Address - Fax:
Practice Address - Street 1:7456 E HUNTINGTON DR
Practice Address - Street 2:SUITE #1
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4061
Practice Address - Country:US
Practice Address - Phone:330-774-7448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH351397163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse