Healthcare Provider Details

I. General information

NPI: 1467609057
Provider Name (Legal Business Name): NANCY SUE JEFFERS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9687 LARUE MOUNT VICTORY RD
LA RUE OH
43332-8809
US

IV. Provider business mailing address

9687 LARUE MT. VICTORY ROAD
LA RUE OH
43332-8809
US

V. Phone/Fax

Practice location:
  • Phone: 740-499-3481
  • Fax:
Mailing address:
  • Phone: 740-499-3481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN233765
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: