Healthcare Provider Details

I. General information

NPI: 1891880027
Provider Name (Legal Business Name): ELAINE JEFFRESS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2978
US

IV. Provider business mailing address

PO BOX 37215
BALTIMORE MD
21297-3215
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-5371
  • Fax: 202-476-6521
Mailing address:
  • Phone: 202-476-5371
  • Fax: 202-476-6521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN1006706
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: