Provider Demographics
NPI:1962053074
Name:JENKINS, CONSTANCE ADELL
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:ADELL
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1356
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95967-1356
Mailing Address - Country:US
Mailing Address - Phone:530-327-8801
Mailing Address - Fax:
Practice Address - Street 1:2920 CLARK RD SPC 16B
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-9140
Practice Address - Country:US
Practice Address - Phone:530-813-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG01923943747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider