Provider Demographics
NPI:1891288635
Name:JEFFERSON, JULIANNE VENISE (LVN)
Entity Type:Individual
Prefix:MS
First Name:JULIANNE
Middle Name:VENISE
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 N BEATON ST APT 11
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-1258
Mailing Address - Country:US
Mailing Address - Phone:903-851-5843
Mailing Address - Fax:
Practice Address - Street 1:2912 N BEATON ST APT 11
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-1258
Practice Address - Country:US
Practice Address - Phone:903-851-5843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140192164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX04489856OtherDRIVERS LICENSE