Provider Demographics
NPI:1609911718
Name:ANDERSON, JEFFREY E (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5569 N 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-3338
Mailing Address - Country:US
Mailing Address - Phone:414-463-2270
Mailing Address - Fax:
Practice Address - Street 1:5569 N 54TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-3338
Practice Address - Country:US
Practice Address - Phone:414-463-2270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI126501163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse