MEDICARE: ADRIENNE JENKINS BSN, WHCNP

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	163WW0101X	Ambulatory Women's Health Care Registered Nurse	R62096	NM

General Provider Information

NPI Number	:	1184929861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE JENKINS BSN, WHCNP

Provider Business Mailing Address
First Line	:	643 CAMINO DEL MONTE SOL
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-2829
Country	:	US
Telephone Number	:	505-983-8012
Fax Number	:

Provider Business Practice Location Address
First Line	:	643 CAMINO DEL MONTE SOL
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-2829
Country	:	US
Telephone Number	:	505-983-8012
Fax Number	:

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

Provider Enumeration Date	:	01/11/2011
Last Update Date	:	01/11/2011

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