AGATHA JEFFERSON (NPI# 1083967624) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083967624 |
| Entity Type | Individual |
| Full Name | AGATHA JEFFERSON |
| Credential | FNP |
| Practice Address |
800 Devon Ave Park Ridge IL 60068-4760 |
| Practice Telephone | 8478254515 |
| Practice Fax Number | 8478254515 |
| Mailing Telephone | 8478254515 |
| Mailing Fax Number | 8478254515 |
| Enumeration Date | 2012-10-19 |
| Last Update Date | 2015-07-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
209009416 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
800 DEVON AVE |
| City | PARK RIDGE |
| State | IL |
| Zip Code | 60068-4760 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962456954 | Lori Diamos | Physical Therapist | 800 Devon Ave, Suite 125, Park Ridge, IL 60068-4760 | 2006-05-22 |
| 1750993069 | Ryan Lee | Pharmacist | 800 Devon Ave, Park Ridge, IL 60068-4760 | 2020-08-18 |
| 1780295550 | Gwa Optical LLC | Eyewear Supplier (Equipment, not the service) | 800 Devon Ave, Park Ridge, IL 60068-4760 | 2020-08-13 |
| 1710497987 | Portia Cochrane | Nurse Practitioner | 800 Devon Ave, Park Ridge, IL 60068-4760 | 2017-10-02 |
| 1710338710 | Brian Rodriguez | Physical Therapist | 800 Devon Ave, Unit B, Park Ridge, IL 60068-4760 | 2016-06-30 |
| 1952757882 | Matthew Johnson | Physical Therapist | 800 Devon Ave, Park Ridge, IL 60068-4760 | 2016-05-10 |
| 1114381761 | Sunil Thomas | Physical Therapist | 800 Devon Ave, Park Ridge, IL 60068 | 2016-04-11 |
| 1457712697 | Jessica G Haar | Occupational Therapist | 800 Devon Ave, Park Ridge, IL 60068-4760 | 2016-03-16 |
| 1770953325 | Dewey Joern | Physical Therapist | 800 Devon Ave, Unit B, Park Ridge, IL 60068-4760 | 2015-09-25 |
| 1629472352 | Agnieszka Wasilik | Pharmacist | 800 Devon Ave, Park Ridge, IL 60068-4760 | 2014-10-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861010720 | Caitlin Marie Kompanowski | Dentist | 412 W. Talcott, Park Ridge, IL 60068 | 2020-07-08 |
| 1972142198 | Center for Authentic Living, Inc. | Counselor | 120 Main Street Suite 200, Park Ridge, IL 60068 | 2020-01-06 |
| 1306312152 | Maryann Almores Devilla | Physical Medicine & Rehabilitation | Sunrise Assisted Living, 1725 Ballard Road, Park Ridge, IL 60068 | 2018-10-19 |
| 1053808857 | Landon Ginsberg | Student in an Organized Health Care Education/Training Program | 1775 Ballard, Park Ridge, IL 60068 | 2018-04-17 |
| 1255828448 | Vera W Brink | Obstetrics & Gynecology | Parkside Professional Center, 1875 Dempster St., Ste. 330, Park Ridge, IL 60068 | 2018-04-13 |
| 1205367448 | Courtney Heim | Psychiatry & Neurology | 1875 W.dempster Street - Park Side Professional Center, Ste 470, Park Ridge, IL 60068 | 2017-03-21 |
| 1720521362 | Alexander Mylonas | Psychologist | 1400 Renaissance Dr Ste 401, Park Ridge, IL 60068 | 2016-11-30 |
| 1376090878 | Rebecca Rajasekhar | Audiologist | 1030 W. Higgins Rd., Audiology Room 6, Park Ridge, IL 60068 | 2016-09-01 |
| 1164818449 | Mohammad Taha Mustaf Taha Mustafa Sheikh | Student in an Organized Health Care Education/Training Program | 1550 North Northwest Highway Suite 107, L.m. Prasad, Md, Sc, Park Ridge, IL 60068 | 2015-04-13 |
| 1518397918 | Megan Roberts | Speech-Language Pathologist | 2240 Campus Dr., Evanston, IL 60068 | 2013-11-21 |
| Find all providers in zip 60068 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548873391 | Swapna C Kappan | Nurse Practitioner | 1875 W Dempster St Ste 605, Park Ridge, IL 60068-1168 | 2020-08-30 |
| 1114543055 | Michael Castaneda | Nurse Practitioner | 1875 Dempster St Ste 110, Park Ridge, IL 60068-1125 | 2020-06-16 |
| 1659935336 | Meera Sharma | Nurse Practitioner | 1875 W Dempster St Ste 180, Park Ridge, IL 60068-1144 | 2019-04-27 |
| 1720596166 | Leticia Mendez | Nurse Practitioner | 1875 Dempster St Ste 265, Park Ridge, IL 60068-1126 | 2018-01-19 |
| 1649791195 | Kenneth Torres Lazaro | Nurse Practitioner | 1775 Dempster St Rm E592b, Park Ridge, IL 60068-1143 | 2017-07-05 |
| 1942602461 | Daniel Glon | Nurse Practitioner | 1775 Dempster Street Advocate Lutheran General Hospital, Park Ridge, IL 60668 | 2014-09-17 |
| 1457650285 | Marian Catalano | Nurse Practitioner | 1675 Dempster St # Y3-254, Park Ridge, IL 60068-1110 | 2011-03-18 |
| 1477665784 | Maria Cataldo | Nurse Practitioner | 1000 Greendale Ave, Park Ridge, IL 60068-2053 | 2006-08-31 |
| 1245847656 | Susie Annette Gonzalez | Nurse Practitioner | 1775 Dempster St, Park Ridge, IL 60068-1143 | 2020-09-29 |
| 1871109876 | Jenny Yohannan | Nurse Practitioner | 1600 Dempster St Ste 120, Park Ridge, IL 60068-1171 | 2020-09-16 |
| Find all providers in PARK RIDGE | ||||
| City | PARK RIDGE |
| Zip Code | 60068 |
Please comment or provide details below to improve the information on AGATHA JEFFERSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.