MEDICARE: MRS. DEBORAH BISHOP JEFFERSON APN-CNP

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
1	363L00000X	Nurse Practitioner	209005152	IL
2	363LF0000X	Family Nurse Practitioner	209005152	IL

General Provider Information

NPI Number	:	1033150644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH BISHOP JEFFERSON APN-CNP

Provider Business Mailing Address
First Line	:	1339 W ALBION AVE
Second Line	:	#2W
City	:	CHICAGO
State	:	IL
Zip	:	60626-4701
Country	:	US
Telephone Number	:	773-973-0393
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 N CHILDRENS PLZ
Second Line	:	DIVISION OF CARDIOLOGY
City	:	CHICAGO
State	:	IL
Zip	:	60614-3363
Country	:	US
Telephone Number	:	773-880-6957
Fax Number	:	773-880-8111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	04/09/2026

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