Provider Demographics
NPI:1992074009
Name:JEFFERIES, KATHRYN ELLEN (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ELLEN
Last Name:JEFFERIES
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 1:15 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NY
Mailing Address - Zip Code:14727-1014
Mailing Address - Country:US
Mailing Address - Phone:585-968-1760
Mailing Address - Fax:
Practice Address - Street 1:15 ELM ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-1014
Practice Address - Country:US
Practice Address - Phone:585-968-1760
Practice Address - Fax:585-968-3181
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298414-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse