Provider Demographics
NPI:1427516962
Name:PLUNKETT, EVANGELINE ROYON
Entity type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:ROYON
Last Name:PLUNKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5912 NE 112TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-5953
Mailing Address - Country:US
Mailing Address - Phone:360-852-8249
Mailing Address - Fax:360-852-8276
Practice Address - Street 1:5912 NE 112TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-5953
Practice Address - Country:US
Practice Address - Phone:360-852-8249
Practice Address - Fax:360-852-8276
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA753951311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home