Provider Demographics
NPI:1528336443
Name:JEFFERSON, FELISHA FIONNE (RN)
Entity type:Individual
Prefix:MRS
First Name:FELISHA
Middle Name:FIONNE
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12011 MILLSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1506
Mailing Address - Country:US
Mailing Address - Phone:301-262-0911
Mailing Address - Fax:
Practice Address - Street 1:12011 MILLSTREAM DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1506
Practice Address - Country:US
Practice Address - Phone:301-262-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR164312163W00000X
DCRN1004587163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse