Provider Demographics
NPI:1447999776
Name:JENKS, ANGELA JOANNE
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JOANNE
Last Name:JENKS
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 1:19143 SHADYSIDE ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1316
Mailing Address - Country:US
Mailing Address - Phone:248-880-8079
Mailing Address - Fax:
Practice Address - Street 1:19143 SHADYSIDE ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1316
Practice Address - Country:US
Practice Address - Phone:248-880-8079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty