Provider Demographics
NPI:1053860759
Name:JEFFERSON, JANICE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:
Last Name:JEFFERSON
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 1:9060 UNION TPKE
Mailing Address - Street 2:18C
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-8003
Mailing Address - Country:US
Mailing Address - Phone:347-675-9812
Mailing Address - Fax:
Practice Address - Street 1:9060 UNION TPKE
Practice Address - Street 2:18C
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-8003
Practice Address - Country:US
Practice Address - Phone:347-675-9812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY437431163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse