Individual
DANITA JEFFERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4911 N CAMAC ST, PHILADELPHIA, PA 19141-3503
(215) 805-0675
Mailing address
4911 N CAMAC ST, PHILADELPHIA, PA 19141-3503
(215) 805-0675
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
304470
PA
Other
Enumeration date
04/25/2019
Last updated
04/25/2019
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