Provider Demographics
NPI:1801906870
Name:JEFFRIES, NANCY (DO)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-9778
Mailing Address - Country:US
Mailing Address - Phone:717-721-9068
Mailing Address - Fax:
Practice Address - Street 1:617 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9778
Practice Address - Country:US
Practice Address - Phone:717-721-9068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006305L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA40473OtherGEISINGER HEALTH PLAN
MD925456OtherCAREFIRST MD BCBS
PA001142127Medicaid
PA133827OtherBLUE SHIELD
PA001142127Medicaid
PA133827Medicare PIN