Provider Demographics
NPI:1568763811
Name:JEFFRIES, GLENDA MARETT (FNP)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:MARETT
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8331 BANDFORD WAY
Mailing Address - Street 2:SUITE101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2770
Mailing Address - Country:US
Mailing Address - Phone:919-841-4566
Mailing Address - Fax:919-841-4568
Practice Address - Street 1:8331 BANDFORD WAY
Practice Address - Street 2:SUITE101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2770
Practice Address - Country:US
Practice Address - Phone:919-841-4566
Practice Address - Fax:919-841-4568
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily