Provider Demographics
NPI:1447913967
Name:PLUMMER, ELIZABETH SUSAN (RD)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:SUSAN
Other - Last Name:CUSHING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1040 N MASON RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6361
Mailing Address - Country:US
Mailing Address - Phone:314-996-0183
Mailing Address - Fax:
Practice Address - Street 1:12634 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6337
Practice Address - Country:US
Practice Address - Phone:314-747-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered