Individual
AGATHA JEFFERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1825 WILLOW RD, NORTHFIELD, IL 60093-2925
(847) 825-4515
(847) 825-4515
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
277-001682
IL
363LF0000X
Family Nurse Practitioner
209009416
IL
Other
Enumeration date
10/19/2012
Last updated
01/27/2025
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