Provider Demographics
NPI:1508192121
Name:JEFFERS, NANCY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ANN
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 S KING ST STE 302
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1951
Mailing Address - Country:US
Mailing Address - Phone:707-245-6330
Mailing Address - Fax:707-237-3685
Practice Address - Street 1:1150 S KING ST STE 302
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1951
Practice Address - Country:US
Practice Address - Phone:707-245-6330
Practice Address - Fax:707-237-3685
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-20743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010C96039OtherBCBS
MIF07121Medicare UPIN