Provider Demographics
NPI:1366652745
Name:JEFFERS, LISA A (CRNP, CWS)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:CRNP, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9291 BEL AIR DR
Mailing Address - Street 2:
Mailing Address - City:MARDELA SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:21837-2106
Mailing Address - Country:US
Mailing Address - Phone:410-251-6983
Mailing Address - Fax:
Practice Address - Street 1:100 E CARROLL ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5422
Practice Address - Country:US
Practice Address - Phone:410-677-6605
Practice Address - Fax:410-677-6616
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR168142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily