Provider Demographics
NPI:1639463151
Name:JEFFERS, PRINCESS (CNC)
Entity Type:Individual
Prefix:
First Name:PRINCESS
Middle Name:
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:
Other - First Name:PRINCESS
Other - Middle Name:
Other - Last Name:JEFFERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT, CIMI
Mailing Address - Street 1:PO BOX 35229
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-0229
Mailing Address - Country:US
Mailing Address - Phone:804-592-4751
Mailing Address - Fax:804-592-4752
Practice Address - Street 1:8014 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE 200 A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-5291
Practice Address - Country:US
Practice Address - Phone:804-592-4751
Practice Address - Fax:804-592-4752
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019005982133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist