Provider Demographics
NPI:1225596141
Name:PLUMMER, BRANDY MONIQUE
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:MONIQUE
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 1:13195 WARWICK BLVD STE 2E
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-8313
Mailing Address - Country:US
Mailing Address - Phone:757-378-4806
Mailing Address - Fax:
Practice Address - Street 1:13195 WARWICK BLVD STE 2E
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-8313
Practice Address - Country:US
Practice Address - Phone:757-378-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-10
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002092072164W00000X
251C00000X
VAHCO-232776251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No251C00000XAgenciesDay Training, Developmentally Disabled Services