Provider Demographics
NPI:1427626332
Name:LEFEVER, JOLEEN MERIDALE (LMT)
Entity type:Individual
Prefix:
First Name:JOLEEN
Middle Name:MERIDALE
Last Name:LEFEVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JOLEEN
Other - Middle Name:MERIDALE
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2115 BRADWAY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-5501
Mailing Address - Country:US
Mailing Address - Phone:907-388-2280
Mailing Address - Fax:
Practice Address - Street 1:910 OLD STEESE HWY
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3168
Practice Address - Country:US
Practice Address - Phone:907-328-5965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK175848225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist