Provider Demographics
NPI:1356038863
Name:JEFFERSON, VANESSA MARIE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIE
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 1:1458 CLEARAIRE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-2805
Mailing Address - Country:US
Mailing Address - Phone:216-301-0744
Mailing Address - Fax:
Practice Address - Street 1:1458 CLEARAIRE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-2805
Practice Address - Country:US
Practice Address - Phone:216-301-0744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUQ316709376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker