Provider Demographics
NPI:1093531964
Name:JEFFERSON, LIZZIE (PERSONAL CARE)
Entity type:Individual
Prefix:
First Name:LIZZIE
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:PERSONAL CARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 COUNTY RD APT 101
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1321
Mailing Address - Country:US
Mailing Address - Phone:202-409-7751
Mailing Address - Fax:
Practice Address - Street 1:1912 COUNTY RD APT 101
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-1321
Practice Address - Country:US
Practice Address - Phone:202-409-7751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty