Healthcare Provider Details

I. General information

NPI: 1699734111
Provider Name (Legal Business Name): ELIZABETH S PLUMMER RN BC GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: E SHARON PLUMMER

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N US HIGHWAY 89 BUILDING 70, ROOM 131
PRESCOTT AZ
86313-5001
US

IV. Provider business mailing address

500 N US HIGHWAY 89 BUILDING 70, ROOM 131
PRESCOTT AZ
86313-5001
US

V. Phone/Fax

Practice location:
  • Phone: 928-776-5461
  • Fax: 928-776-6181
Mailing address:
  • Phone: 928-776-5461
  • Fax: 928-776-6181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP3754
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN168345
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number22210572
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: