Provider Demographics
NPI:1215796503
Name:PLUMMER, EMANUELA MARIANNA (PA-C)
Entity type:Individual
Prefix:
First Name:EMANUELA
Middle Name:MARIANNA
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMANUELA
Other - Middle Name:M
Other - Last Name:PLUMMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:800-994-0371
Mailing Address - Fax:254-215-9722
Practice Address - Street 1:10526 W PARMER LN BLDG 4
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5056
Practice Address - Country:US
Practice Address - Phone:512-310-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA17875363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant