Provider Demographics
NPI:1538581590
Name:PLUMMER, JACQUELINE D (BSN, RN)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:D
Last Name:PLUMMER
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Gender:F
Credentials:BSN, RN
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Mailing Address - Street 1:300 EAST HOSPITAL ROAD
Mailing Address - Street 2:DDEAMC FAMILY PRACTICE CLINIC, 2ND FLOOR
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:706-787-2927
Mailing Address - Fax:706-787-9356
Practice Address - Street 1:300 E HOSPITAL ROAD
Practice Address - Street 2:DDEAMC, FAMILY PRACTICE CLINIC, 2ND FLOOR
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-2927
Practice Address - Fax:706-787-9356
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC125337163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC125337OtherNURSE LICENSURE