Provider Demographics
NPI:1487946141
Name:PLUMMER, JESSICA LAUREN (CPNP)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LAUREN
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:LAUREN
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:105 MILLBURY ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501
Mailing Address - Country:US
Mailing Address - Phone:508-832-9691
Mailing Address - Fax:508-832-7670
Practice Address - Street 1:105 MILLBURY ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501
Practice Address - Country:US
Practice Address - Phone:508-832-9691
Practice Address - Fax:508-832-7670
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2258709363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner