Provider Demographics
NPI:1407029317
Name:JEFFERY, DIXIE LEA (LPN)
Entity Type:Individual
Prefix:MS
First Name:DIXIE
Middle Name:LEA
Last Name:JEFFERY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2493 ROUND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LUCK
Mailing Address - State:WI
Mailing Address - Zip Code:54853-5302
Mailing Address - Country:US
Mailing Address - Phone:715-472-2623
Mailing Address - Fax:
Practice Address - Street 1:2493 ROUND LAKE RD
Practice Address - Street 2:
Practice Address - City:LUCK
Practice Address - State:WI
Practice Address - Zip Code:54853-5302
Practice Address - Country:US
Practice Address - Phone:715-472-2623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13972-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse