Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN117622 | GA |
NPI | 1023064359 |
---|---|
Provider Name | Dana Jenkins |
First Address | Fort Gordon, GA 30905-5741 |
Second Address | Fort Gordon, GA 30905-5741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 08/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000871406A | (05) | GA |
000871406B | (05) | GA |
NPO386 | (05) | SC |
P06949 | (02) | GA |