Healthcare Provider Details

I. General information

NPI: 1225596141
Provider Name (Legal Business Name): MRS. BRANDY MONIQUE PLUMMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2019
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13195 WARWICK BLVD STE 2E
NEWPORT NEWS VA
23602-8313
US

IV. Provider business mailing address

13195 WARWICK BLVD STE 2E
NEWPORT NEWS VA
23602-8313
US

V. Phone/Fax

Practice location:
  • Phone: 757-378-4806
  • Fax:
Mailing address:
  • Phone: 757-378-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-232776
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number0002092072
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: