Healthcare Provider Details

I. General information

NPI: 1184812109
Provider Name (Legal Business Name): ANNE L JEFFCOTT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE L JEFFCOTT CNP

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 E 3RD ST
WAVERLY OH
45690-1572
US

IV. Provider business mailing address

308 WOODVIEW DR
CHILLICOTHEE OH
45601-9722
US

V. Phone/Fax

Practice location:
  • Phone: 740-947-3010
  • Fax:
Mailing address:
  • Phone: 740-851-6120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number260798
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: