Provider Demographics
NPI:1144533159
Name:JEFFERS, CHERYL L (CNP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:419-473-3561
Mailing Address - Fax:
Practice Address - Street 1:1661 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4207
Practice Address - Country:US
Practice Address - Phone:419-843-7800
Practice Address - Fax:419-843-7800
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA11619NP363LF0000X
OHCOA 11619-NP207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCOA11619NPOtherOH CNP LICENSE
MI1144533159Medicaid
OH3070948Medicaid
MI1144533159Medicaid