Provider Demographics
NPI:1164998050
Name:PLOTKE, JETTA (RN)
Entity Type:Individual
Prefix:
First Name:JETTA
Middle Name:
Last Name:PLOTKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN STE B122
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6806
Mailing Address - Country:US
Mailing Address - Phone:972-383-1060
Mailing Address - Fax:972-383-1061
Practice Address - Street 1:7777 FOREST LN STE B122
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6806
Practice Address - Country:US
Practice Address - Phone:972-383-1060
Practice Address - Fax:972-383-1061
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX636799163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management