Provider Demographics
NPI:1598261307
Name:LEFLORE-JEFFERSON, ELAINE (RN)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:LEFLORE-JEFFERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 N NORDICA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4320
Mailing Address - Country:US
Mailing Address - Phone:708-714-0790
Mailing Address - Fax:
Practice Address - Street 1:2334 N NEVA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-2815
Practice Address - Country:US
Practice Address - Phone:773-671-2147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041348531163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse