=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609161280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUZANNE M. H. JENKINS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2011
-----------------------------------------------------
Last Update Date | 04/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23 ERIC NORD WAY STE 1
-----------------------------------------------------
City | OBERLIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44074-1583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-533-9191
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 S MAIN ST STE 129
-----------------------------------------------------
City | OBERLIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44074-1626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-697-0742
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 131434
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------