MEDICARE: SHEA WAN PLUMMER RN

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	163W00000X	Registered Nurse	9599809	FL

General Provider Information

NPI Number	:	1215866116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEA WAN PLUMMER RN

Provider Business Mailing Address
First Line	:	9137 FLYING EAGLE DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-6083
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9145 FLYING EAGLE DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-6084
Country	:	US
Telephone Number	:	904-868-0209
Fax Number	:

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

Provider Enumeration Date	:	05/16/2026
Last Update Date	:	05/16/2026

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