Provider Demographics
NPI:1699734111
Name:PLUMMER, ELIZABETH S (RN BC GNP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:S
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:RN BC GNP
Other - Prefix:
Other - First Name:E
Other - Middle Name:SHARON
Other - Last Name:PLUMMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:500 N US HIGHWAY 89
Mailing Address - Street 2:BUILDING 70, ROOM 131
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86313-5001
Mailing Address - Country:US
Mailing Address - Phone:928-776-5461
Mailing Address - Fax:928-776-6181
Practice Address - Street 1:500 N US HIGHWAY 89
Practice Address - Street 2:BUILDING 70, ROOM 131
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313-5001
Practice Address - Country:US
Practice Address - Phone:928-776-5461
Practice Address - Fax:928-776-6181
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3754363LG0600X
AZRN168345163W00000X
AZ22210572163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS85221Medicare UPIN