Provider Demographics
NPI:1568104610
Name:MEDEIROS, JEFFREY AUGUST (LPN)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:AUGUST
Last Name:MEDEIROS
Suffix:
Gender:M
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:PO BOX 41094
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02940
Mailing Address - Country:US
Mailing Address - Phone:508-965-4617
Mailing Address - Fax:
Practice Address - Street 1:22 FRONT ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-4302
Practice Address - Country:US
Practice Address - Phone:508-676-1307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN57806164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse