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General NPI Number Information
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NPI Number | 1538581590
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Entity Type | Individual
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Provider Name | JACQUELINE D PLUMMER BSN, RN
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Gender | Female
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Dates
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Enumeration Date | 01/10/2014
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 300 E HOSPITAL ROAD DDEAMC, FAMILY PRACTICE CLINIC, 2ND FLOOR
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City | FORT GORDON
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State | GA
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Zip | 30905-5650
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Country | US
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Telephone | 706-787-2927
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Fax | 706-787-9356
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Provider Business Mailing Address
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Address Line | 300 EAST HOSPITAL ROAD DDEAMC FAMILY PRACTICE CLINIC, 2ND FLOOR
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City | FORT GORDON
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State | GA
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Zip | 30905-5650
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Country | US
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Telephone | 706-787-2927
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Fax | 706-787-9356
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 125337
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License Number State | NC
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