Individual
JED LEIFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3630 WILLOWCREEK RD, PORTAGE, IN 46368-5075
(219) 364-3000
Mailing address
28 N PALAFOX ST, PENSACOLA, FL 32502-5626
(941) 360-1566
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28255655A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
130221
IN
Other
Enumeration date
12/15/2019
Last updated
02/05/2020
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