MEDICARE: MISS ELIZABETH CHERITA JENKINS NP

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	363LF0000X	Family Nurse Practitioner	4704163024	MI

General Provider Information

NPI Number	:	1215029277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ELIZABETH CHERITA JENKINS NP

Provider Business Mailing Address
First Line	:	4534 WEST OUTER DRIVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-1210
Country	:	US
Telephone Number	:	248-798-6753
Fax Number	:

Provider Business Practice Location Address
First Line	:	18101 OAKWOOD BLVD
Second Line	:	INTERIM STAY UNIT
City	:	DEARBORN
State	:	MI
Zip	:	48123-4089
Country	:	US
Telephone Number	:	313-982-5770
Fax Number	:	313-982-5771

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	09/14/2009

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