Provider Demographics
NPI:1477019628
Name:PLOTADO, AUREA (RN)
Entity Type:Individual
Prefix:
First Name:AUREA
Middle Name:
Last Name:PLOTADO
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 1:4219 W VILLA MARIA DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1716
Mailing Address - Country:US
Mailing Address - Phone:808-343-8177
Mailing Address - Fax:
Practice Address - Street 1:4219 W VILLA MARIA DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1716
Practice Address - Country:US
Practice Address - Phone:808-343-8177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN180258163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty