Provider Demographics
NPI:1427723626
Name:PLUNKETT, SEBREANA C (ADMINISTRATOR)
Entity type:Individual
Prefix:
First Name:SEBREANA
Middle Name:C
Last Name:PLUNKETT
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:SEBREANA
Other - Middle Name:C
Other - Last Name:PLUNKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ADMINISTRATOR
Mailing Address - Street 1:7002 HODGSON MEMORIAL DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2586
Mailing Address - Country:US
Mailing Address - Phone:912-346-8982
Mailing Address - Fax:
Practice Address - Street 1:7002 HODGSON MEMORIAL DR STE 106
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2586
Practice Address - Country:US
Practice Address - Phone:912-346-8982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty