Individual
MR. JUSTIN MATTHEW JEFFERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 326-4325
Mailing address
611 W. PARK ST., FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209.025128
IL
363LF0000X
Family Nurse Practitioner
Primary
209025128
IL
Other
Enumeration date
10/07/2022
Last updated
05/05/2023
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