1598005563 NPI number — ELIZABETH BROUILLETTE PLUMMER APRN

Table of content: ELIZABETH BROUILLETTE PLUMMER APRN (NPI 1598005563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598005563 NPI number — ELIZABETH BROUILLETTE PLUMMER APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLUMMER
Provider First Name:
ELIZABETH
Provider Middle Name:
BROUILLETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598005563
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10511 MISSION RD
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
LEAWOOD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66206-2708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-800-1026
Provider Business Mailing Address Fax Number:
913-541-5953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10511 MISSION RD
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
LEAWOOD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66206-2708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-800-1026
Provider Business Practice Location Address Fax Number:
913-541-5953
Provider Enumeration Date:
02/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  2011029758 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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