Provider Demographics
NPI:1043504202
Name:PLUMMER, SHENNAE (LPN)
Entity type:Individual
Prefix:MRS
First Name:SHENNAE
Middle Name:
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E 223RD ST
Mailing Address - Street 2:PH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4602
Mailing Address - Country:US
Mailing Address - Phone:347-867-4328
Mailing Address - Fax:
Practice Address - Street 1:920 E 223RD ST
Practice Address - Street 2:PH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4602
Practice Address - Country:US
Practice Address - Phone:347-867-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305055-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse