Provider Demographics
NPI:1245055094
Name:PLUMMER, JUANITA FAYE (LPN)
Entity type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:FAYE
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9924 GRAPEVINE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-5639
Mailing Address - Country:US
Mailing Address - Phone:501-471-6322
Mailing Address - Fax:
Practice Address - Street 1:9924 GRAPEVINE DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-5639
Practice Address - Country:US
Practice Address - Phone:501-471-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL059945164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse