Individual
EDITH JENKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1515 FOREST AVE, CALUMET CITY, IL 60409-6218
(708) 743-0365
(708) 432-6699
Mailing address
1515 FOREST AVE, CALUMET CITY, IL 60409-6218
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71007161A
IN
363LF0000X
Family Nurse Practitioner
F01171312
IL
Other
Enumeration date
02/02/2017
Last updated
12/29/2019
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