Provider Demographics
NPI:1447487905
Name:PLUMMER, DEBRA
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3056 LONG COMMON PKWY
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-8823
Mailing Address - Country:US
Mailing Address - Phone:630-674-7658
Mailing Address - Fax:
Practice Address - Street 1:307 STRATFORD PL
Practice Address - Street 2:APT 23
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2647
Practice Address - Country:US
Practice Address - Phone:630-674-7658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist