Provider Demographics
NPI:1598298424
Name:SEVERSON, JEFFREY ROBERT (LPN)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ROBERT
Last Name:SEVERSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-6946
Mailing Address - Country:US
Mailing Address - Phone:605-216-7908
Mailing Address - Fax:
Practice Address - Street 1:1754 S 3RD ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-6946
Practice Address - Country:US
Practice Address - Phone:605-216-7908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A2018904146M00000X
SDP011001164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
No164W00000XNursing Service ProvidersLicensed Practical Nurse