Provider Demographics
NPI:1326409590
Name:JEFFERSON, VICTORIA (RN, BSN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16151 CAIRNWAY DR
Mailing Address - Street 2:208
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-3550
Mailing Address - Country:US
Mailing Address - Phone:832-986-2797
Mailing Address - Fax:281-656-8289
Practice Address - Street 1:16151 CAIRNWAY DR
Practice Address - Street 2:208
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-3550
Practice Address - Country:US
Practice Address - Phone:832-986-2797
Practice Address - Fax:281-656-8289
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX776501163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health