Provider Demographics
NPI:1811181530
Name:JEFFERY, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:JEFFERY
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 1:735 OLD LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3414
Mailing Address - Country:US
Mailing Address - Phone:610-527-9360
Mailing Address - Fax:610-527-9361
Practice Address - Street 1:735 OLD LANCASTER RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3414
Practice Address - Country:US
Practice Address - Phone:610-527-9360
Practice Address - Fax:610-527-9361
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003745133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist