Provider Demographics
NPI:1811281306
Name:JEFFERSON, ALECIA (APRN, CDCES)
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:APRN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9449 S KEDZIE AVE # 560
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2325
Mailing Address - Country:US
Mailing Address - Phone:312-488-9392
Mailing Address - Fax:
Practice Address - Street 1:9449 S KEDZIE AVE # 560
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2325
Practice Address - Country:US
Practice Address - Phone:312-488-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21700682163WD0400X
IL209.008722363LF0000X
IL209008722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty