Provider Demographics
NPI:1033150644
Name:JEFFERSON, DEBORAH BISHOP (APN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:BISHOP
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:1339 W ALBION AVE
Mailing Address - Street 2:#2W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4701
Mailing Address - Country:US
Mailing Address - Phone:773-973-0393
Mailing Address - Fax:
Practice Address - Street 1:2300 N CHILDRENS PLZ
Practice Address - Street 2:DIVISION OF CARDIOLOGY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-880-6957
Practice Address - Fax:773-880-8111
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
210066Medicare ID - Type Unspecified
K11088Medicare UPIN