Provider Demographics
NPI:1386901114
Name:JENKINS, MICHELLE D (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:JENKINS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 S 58TH ST
Mailing Address - Street 2:SUITE W
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6402
Mailing Address - Country:US
Mailing Address - Phone:402-423-6402
Mailing Address - Fax:402-423-6422
Practice Address - Street 1:5930 S 58TH ST
Practice Address - Street 2:SUITE W
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6402
Practice Address - Country:US
Practice Address - Phone:402-423-6402
Practice Address - Fax:402-423-6422
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE656996163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant