Individual
DAMECIA L JEFFERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
706 MANNINGTON DR, DALLAS, TX 75232-3150
(504) 206-8026
Mailing address
706 MANNINGTON DR, DALLAS, TX 75232-3150
(504) 206-8026
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
1009860
TX
164X00000X
Licensed Vocational Nurse
1009860
TX
Other
Enumeration date
08/28/2020
Last updated
08/28/2020
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