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NPI Code Detail

MEDICARE: NONI GAZELLE JEFFERSON

MEDICARE: NONI GAZELLE 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
1363LG0600XGerontology Nurse Practitioner5012215NC
2363LA2200XAdult Health Nurse Practitioner5012215NC
3163W00000XRegistered Nurse248305NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871140319
Entity Type Code : Individual
Provider Name (Legal Business Name) : NONI GAZELLE JEFFERSON
Provider Business Mailing Address
First Line : 5730 EXECUTIVE DR STE 230
Second Line :
City : CATONSVILLE
State : MD
Zip : 21228-1762
Country : US
Telephone Number : 704-443-6250
Fax Number : 704-443-6279
Provider Business Practice Location Address
First Line : 2030 WINDSOR RUN LN
Second Line :
City : MATTHEWS
State : NC
Zip : 28105-0054
Country : US
Telephone Number : 704-443-6250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2019
Last Update Date : 03/19/2026

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