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General NPI Number Information
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NPI Number | 1831682095
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Entity Type | Individual
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Provider Name | MARCIA M JEFFERSON NP
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Gender | Female
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 6612 E 75TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2875
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Country | US
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Telephone | 317-972-1180
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Fax |
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Provider Business Mailing Address
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Address Line | 440 E NORTH ST APT 102
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-3378
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Country | US
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Telephone | 757-532-1051
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 71007705A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 28153215A
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License Number State | IN
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