MICHAEL D JEFFERSON

DECATUR, IL
NPI1972709806
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy164W00000X Licensed Practical Nurse
(Licence: IL  043-103558)
Enumeration Date2007-06-26
Last Update Date2007-07-08
Business Address
-- MICHAEL D JEFFERSON
151 N MAIN ST
DECATUR, IL 62523-1206
Phone number: 217-362-6262
Mailing Address
-- MICHAEL D JEFFERSON
PO BOX 710
DECATUR, IL 62525-0710
Phone number: 217-362-6262
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