Provider Demographics
NPI:1598005563
Name:PLUMMER, ELIZABETH BROUILLETTE (APRN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BROUILLETTE
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10511 MISSION RD
Mailing Address - Street 2:STE 201
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-2708
Mailing Address - Country:US
Mailing Address - Phone:913-800-1026
Mailing Address - Fax:913-541-5953
Practice Address - Street 1:10511 MISSION RD
Practice Address - Street 2:STE 201
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-2708
Practice Address - Country:US
Practice Address - Phone:913-800-1026
Practice Address - Fax:913-541-5953
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011029758363LF0000X
KS13104320122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2206004Medicare Oscar/Certification
MOMA4179004Medicare Oscar/Certification
MOMA3358004Medicare Oscar/Certification