Provider Demographics
NPI:1104169002
Name:JENKINS, DEBRA J (MED)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:J
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 VILLAGE WAY APT B
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2054
Mailing Address - Country:US
Mailing Address - Phone:508-813-1610
Mailing Address - Fax:
Practice Address - Street 1:15 VILLAGE WAY APT B
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-2054
Practice Address - Country:US
Practice Address - Phone:508-813-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator