Provider Demographics
NPI:1225684046
Name:PLOTT, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:PLOTT
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 1:13825 W DESERT COVE RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-9702
Mailing Address - Country:US
Mailing Address - Phone:623-876-7923
Mailing Address - Fax:
Practice Address - Street 1:13825 W DESERT COVE RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-9702
Practice Address - Country:US
Practice Address - Phone:623-876-7923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPN.0335146164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse