Provider Demographics
NPI:1447719752
Name:JEFFRIES, CHRISTINE NICOLE (MA, QMHA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:NICOLE
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:MA, QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 CHURCH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3796
Mailing Address - Country:US
Mailing Address - Phone:503-373-3819
Mailing Address - Fax:503-588-6465
Practice Address - Street 1:360 CHURCH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3796
Practice Address - Country:US
Practice Address - Phone:503-373-3819
Practice Address - Fax:503-588-6465
Is Sole Proprietor?:No
Enumeration Date:2019-03-16
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH363AM0700X
OR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical