Provider Demographics
NPI:1174882666
Name:PLUMMER, ERIN ANNE (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ANNE
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:ANNE
Other - Last Name:FORSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1835 COUNTY ROAD C W STE 30
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1125
Mailing Address - Country:US
Mailing Address - Phone:651-426-0698
Mailing Address - Fax:651-426-6439
Practice Address - Street 1:347 SMITH AVE N STE 505
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-220-6260
Practice Address - Fax:651-220-7777
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN59215390200000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty