Individual
MS. NICOLE L JEFFERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
3242 20TH ST S, FARGO, ND 58104
(701) 893-2639
(701) 893-2638
Mailing address
3242 20TH ST S, FARGO, ND 58104
(701) 893-2639
(701) 893-2638
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2071
ND
2251X0800X
Orthopedic Physical Therapist
2071
ND
Other
Enumeration date
05/08/2018
Last updated
04/11/2019
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