MEDICARE: MRS. ELIZABETH S PLUMMER RN BC GNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	AP3754	AZ
2	163W00000X	Registered Nurse	RN168345	AZ
3	163WD0400X	Diabetes Educator Registered Nurse	22210572	AZ

General Provider Information

NPI Number	:	1699734111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH S PLUMMER RN BC GNP

Provider Business Mailing Address
First Line	:	500 N US HIGHWAY 89
Second Line	:	BUILDING 70, ROOM 131
City	:	PRESCOTT
State	:	AZ
Zip	:	86313-5001
Country	:	US
Telephone Number	:	928-776-5461
Fax Number	:	928-776-6181

Provider Business Practice Location Address
First Line	:	500 N US HIGHWAY 89
Second Line	:	BUILDING 70, ROOM 131
City	:	PRESCOTT
State	:	AZ
Zip	:	86313-5001
Country	:	US
Telephone Number	:	928-776-5461
Fax Number	:	928-776-6181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	05/24/2016

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