Provider Demographics
NPI:1215198288
Name:JEFFERS, DAWN M (MS,RD,CD)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:M
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:MS,RD,CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9811 W BETHEL AVE
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:IN
Mailing Address - Zip Code:47342-9772
Mailing Address - Country:US
Mailing Address - Phone:765-717-5619
Mailing Address - Fax:
Practice Address - Street 1:9811 W BETHEL AVE
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:IN
Practice Address - Zip Code:47342-9772
Practice Address - Country:US
Practice Address - Phone:765-717-5619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-22
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001803A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered