Provider Demographics
NPI:1720484546
Name:PLUMADORE, JAIMIE LYNN
Entity type:Individual
Prefix:
First Name:JAIMIE
Middle Name:LYNN
Last Name:PLUMADORE
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 1:1167 HARDSCRABBLE RD
Mailing Address - Street 2:
Mailing Address - City:CADYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12918-1908
Mailing Address - Country:US
Mailing Address - Phone:518-593-8915
Mailing Address - Fax:
Practice Address - Street 1:1167 HARDSCRABBLE RD
Practice Address - Street 2:
Practice Address - City:CADYVILLE
Practice Address - State:NY
Practice Address - Zip Code:12918-1908
Practice Address - Country:US
Practice Address - Phone:518-593-8915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY687612-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse