Provider Demographics
NPI:1366516148
Name:JEFFERSON, SUSANNE (RNFA)
Entity type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:RNFA
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 670039
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75367-0039
Mailing Address - Country:US
Mailing Address - Phone:214-378-9898
Mailing Address - Fax:214-378-9888
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:MEDICAL CITY DALLAS
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-566-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRN650395163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant