Healthcare Provider Details

I. General information

NPI: 1871885483
Provider Name (Legal Business Name): ALVIN D JEFFERY MSN, RN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2011
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE PATIENT SERVICES APN/ML4019
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVENUE ML5021
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-5463
  • Fax: 513-636-8893
Mailing address:
  • Phone: 513-636-2039
  • Fax: 866-213-7089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.12900-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.332819-COA1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: