MEDICARE: ASHANTI N JENKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1073161170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHANTI N JENKINS

Provider Business Mailing Address
First Line	:	406 MILTON AVE
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13204-1930
Country	:	US
Telephone Number	:	680-800-4407
Fax Number	:

Provider Business Practice Location Address
First Line	:	406 MILTON AVE
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13204-1930
Country	:	US
Telephone Number	:	680-800-4407
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2019
Last Update Date	:	09/01/2019

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Directions to “ ASHANTI N JENKINS ” Practice Location

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