Provider Demographics
NPI:1679823751
Name:PHIFER, JEFF III (LPN)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:
Last Name:PHIFER
Suffix:III
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 1:2810 MCGUFFEY RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-4216
Mailing Address - Country:US
Mailing Address - Phone:330-743-3460
Mailing Address - Fax:330-743-3460
Practice Address - Street 1:2810 MCGUFFEY RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-4216
Practice Address - Country:US
Practice Address - Phone:330-743-3460
Practice Address - Fax:330-743-3460
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 136119-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH164W00000XMedicaid