Provider Demographics
NPI:1730609553
Name:JENNINGS, AMBER MONIQUE (RN)
Entity type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:MONIQUE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 CASTLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35206-1801
Mailing Address - Country:US
Mailing Address - Phone:205-706-3276
Mailing Address - Fax:
Practice Address - Street 1:812 CASTLEWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35206
Practice Address - Country:US
Practice Address - Phone:205-706-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-148823163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-148823OtherRN LICENSE # 1-148823