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NPI Code Detail

MEDICARE: ELISE MEREDITH JEFFERIS RN, LCSW

MEDICARE:   ELISE MEREDITH JEFFERIS  RN, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerCW016433PA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1168201ZDEJOTHERPAMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023229861
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISE MEREDITH JEFFERIS RN, LCSW
Provider Business Mailing Address
First Line : 101 PEMBROKE CT
Second Line :
City : GREENSBURG
State : PA
Zip : 15601-6404
Country : US
Telephone Number : 724-396-1510
Fax Number : 724-691-0476
Provider Business Practice Location Address
First Line : 123 N PITTSBURGH ST
Second Line :
City : ZELIENOPLE
State : PA
Zip : 16063-1229
Country : US
Telephone Number : 724-396-1510
Fax Number : 724-691-0476
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2007
Last Update Date : 02/25/2011

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