Provider Demographics
NPI:1639406655
Name:JEFFERS, STEFANI JO (LPN)
Entity type:Individual
Prefix:
First Name:STEFANI
Middle Name:JO
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8204 BILTMORE DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-7162
Mailing Address - Country:US
Mailing Address - Phone:614-787-7185
Mailing Address - Fax:614-863-6124
Practice Address - Street 1:8204 BILTMORE DR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-7162
Practice Address - Country:US
Practice Address - Phone:614-787-7185
Practice Address - Fax:614-863-6124
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH133605164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse