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NPI Code Detail

MEDICARE: TAMMY G. JEFFERSON

MEDICARE: TAMMY G. JEFFERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse174267NC

General Provider Information

NPI Number : 1437465655
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY G. JEFFERSON
Provider Business Mailing Address
First Line : 284 EXECUTIVE PARK DR
Second Line : SUITE 100
City : CONCORD
State : NC
Zip : 28025-1894
Country : US
Telephone Number : 704-939-1118
Fax Number :
Provider Business Practice Location Address
First Line : 1804 E FRANKLIN ST.
Second Line :
City : MONROE
State : NC
Zip : 28110-2818
Country : US
Telephone Number : 704-283-6040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2010
Last Update Date : 07/31/2013

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