=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134361835
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SASHA HEALTH CARE ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2009
-----------------------------------------------------
Last Update Date | 01/31/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3628 PERTSHALL RD
-----------------------------------------------------
City | FERGUSON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63135-1410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-258-6041
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3628 PERSHALL RD
-----------------------------------------------------
City | FERGUSON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63135-1410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-258-6041
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. PATRICIA ANN JENKINS
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 314-258-6041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------