Provider Demographics
NPI:1962219626
Name:JENKINS, WENDALYN DENISE
Entity type:Individual
Prefix:
First Name:WENDALYN
Middle Name:DENISE
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 1:3435 GENTLE KNOLL ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-5551
Mailing Address - Country:US
Mailing Address - Phone:317-985-4532
Mailing Address - Fax:
Practice Address - Street 1:3435 GENTLE KNOLL ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-5551
Practice Address - Country:US
Practice Address - Phone:317-985-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-311559163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant