Provider Demographics
NPI:1275632952
Name:PLUNKETT, JEANETTE A (PA)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:A
Last Name:PLUNKETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:JEANETTE
Other - Middle Name:A
Other - Last Name:TREBILCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2751 DEL PASO ROAD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835
Practice Address - Country:US
Practice Address - Phone:916-453-5145
Practice Address - Fax:916-419-2616
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17565363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA17565Medicaid
Q30496Medicare UPIN
CAPA17565Medicaid
CAAU312YMedicare PIN