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NPI Code Detail

MEDICARE: JERISSA PLUMMER

MEDICARE: JERISSA PLUMMER
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
1320700000XPhysical Disabilities Residential Treatment Facility

General Provider Information

NPI Number : 1790149151
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERISSA PLUMMER
Provider Business Mailing Address
First Line : 4956 DRIFTING PEBBLE ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89081-3057
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4956 DRIFTING PEBBLE ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89081-3057
Country : US
Telephone Number : 608-512-3251
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2016
Last Update Date : 04/11/2016

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Directions to “ JERISSA PLUMMER ” Practice Location

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