=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811260128
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAMIKA N. JENKINS RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2012
-----------------------------------------------------
Last Update Date | 10/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5732 HILL AVE
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43615-5853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-806-5206
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5732 HILL AVE
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43615-5853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-806-5206
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC2100X
-----------------------------------------------------
Taxonomy Name | Continence Care Registered Nurse
-----------------------------------------------------
License Number | 4704309494
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WW0000X
-----------------------------------------------------
Taxonomy Name | Wound Care Registered Nurse
-----------------------------------------------------
License Number | 4704309494
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163WD0400X
-----------------------------------------------------
Taxonomy Name | Diabetes Educator Registered Nurse
-----------------------------------------------------
License Number | 4704309494
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 163WC1600X
-----------------------------------------------------
Taxonomy Name | Continuing Education/Staff Development Registered Nurse
-----------------------------------------------------
License Number | 4704309494
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 163WE0900X
-----------------------------------------------------
Taxonomy Name | Enterostomal Therapy Registered Nurse
-----------------------------------------------------
License Number | 4704309494
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | PN.116073
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 163WA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
-----------------------------------------------------
License Number | 4704309494
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 163WA2000X
-----------------------------------------------------
Taxonomy Name | Administrator Registered Nurse
-----------------------------------------------------
License Number | 4704309494
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #9
-----------------------------------------------------
Taxonomy Code | 163WP2201X
-----------------------------------------------------
Taxonomy Name | Ambulatory Care Registered Nurse
-----------------------------------------------------
License Number | 4704309494
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #10
-----------------------------------------------------
Taxonomy Code | 163WC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Registered Nurse
-----------------------------------------------------
License Number | 4704309494
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #11
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 4704309494
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #12
-----------------------------------------------------
Taxonomy Code | 163WC0400X
-----------------------------------------------------
Taxonomy Name | Case Management Registered Nurse
-----------------------------------------------------
License Number | 4704309494
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #13
-----------------------------------------------------
Taxonomy Code | 163WH1000X
-----------------------------------------------------
Taxonomy Name | Hospice Registered Nurse
-----------------------------------------------------
License Number | 4704309494
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #14
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number | 4704309494
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #15
-----------------------------------------------------
Taxonomy Code | 163WX1500X
-----------------------------------------------------
Taxonomy Name | Ostomy Care Registered Nurse
-----------------------------------------------------
License Number | 4704309494
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------