Basic Information
| Provider Information | |||||||||
| NPI: | 1871885483 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JEFFERY | ||||||||
| FirstName: | ALVIN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MSN, RN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3333 BURNET AVENUE | ||||||||
| Address2: | ML5021 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452293039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136362039 | ||||||||
| FaxNumber: | 8662137089 | ||||||||
| Practice Location | |||||||||
| Address1: | 3333 BURNET AVE | ||||||||
| Address2: | PATIENT SERVICES APN/ML4019 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452293026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136365463 | ||||||||
| FaxNumber: | 5136368893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2011 | ||||||||
| LastUpdateDate: | 05/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN.332819-COA1 | OH | N | Nursing Service Providers | Registered Nurse | 363LF0000X | COA.12900-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.