Provider Demographics
NPI:1255779526
Name:MCMAHON, JEFFREY M (ADN)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:M
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:ADN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10223 S SAWYER AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-3757
Mailing Address - Country:US
Mailing Address - Phone:708-925-2802
Mailing Address - Fax:
Practice Address - Street 1:10223 S SAWYER AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-3757
Practice Address - Country:US
Practice Address - Phone:708-925-2802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.362432163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse