Provider Demographics
NPI:1821427410
Name:JEFFERSON, NAIMAH
Entity Type:Individual
Prefix:
First Name:NAIMAH
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35300 NANKIN BLVD
Mailing Address - Street 2:STE. 601
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-7222
Mailing Address - Country:US
Mailing Address - Phone:734-261-1842
Mailing Address - Fax:734-261-5287
Practice Address - Street 1:35300 NANKIN BLVD
Practice Address - Street 2:STE. 601
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-7222
Practice Address - Country:US
Practice Address - Phone:734-261-1842
Practice Address - Fax:734-261-5287
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator