Provider Demographics
NPI:1285086926
Name:JEFFERSON, DONNA (BS)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:GIRDWOOD
Mailing Address - State:AK
Mailing Address - Zip Code:99587-0313
Mailing Address - Country:US
Mailing Address - Phone:907-301-8207
Mailing Address - Fax:
Practice Address - Street 1:1000 OMALLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3083
Practice Address - Country:US
Practice Address - Phone:907-349-5552
Practice Address - Fax:907-349-5100
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK102107174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist