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NPI Code Detail

MEDICARE: MALAYSIA JEFFERSON

MEDICARE: MALAYSIA JEFFERSON
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
1164W00000XLicensed Practical Nurse858896NV

General Provider Information

NPI Number : 1255127882
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALAYSIA JEFFERSON
Provider Business Mailing Address
First Line : 4602 INLAND CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-4705
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 250 PILOT RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-3542
Country : US
Telephone Number : 702-982-3292
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2025
Last Update Date : 04/18/2025

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Directions to “ MALAYSIA JEFFERSON ” Practice Location

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