Healthcare Provider Details

I. General information

NPI: 1063182202
Provider Name (Legal Business Name): EVELIN A JENKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2021
Last Update Date: 09/19/2021
Certification Date: 09/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 W ALAMEDA RD
GLENDALE AZ
85310-3601
US

IV. Provider business mailing address

23111 N 67TH AVE
GLENDALE AZ
85310-5728
US

V. Phone/Fax

Practice location:
  • Phone: 623-445-5510
  • Fax:
Mailing address:
  • Phone: 602-663-7616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN126875
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: