Individual
PRISCILLA JENCKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LNM
Contact information
Practice address
374 GRAND AVE, FAIR HAVEN COMMUNITY HEALTH CTR, NEW HAVEN, CT 06513
(203) 777-7411
(203) 777-8604
Mailing address
87 INGRAM STREET, HAMDEN, CT 06517
(203) 287-9706
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
000071
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000254189301
UNITED HEALTHCARE
—
01
—
0000719734
CT CARE
—
01
—
400000071CT01
ANTHEM BCBS
—
01
—
P3597631
OXFORD
—
Enumeration date
09/11/2006
Last updated
07/08/2007
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