Provider Demographics
NPI:1396575676
Name:PLUMMER, TIERRA JACKSON (CPM LM)
Entity type:Individual
Prefix:
First Name:TIERRA
Middle Name:JACKSON
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:CPM LM
Other - Prefix:
Other - First Name:TIERRA
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPM, LM
Mailing Address - Street 1:719 GRAYDON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1620
Mailing Address - Country:US
Mailing Address - Phone:757-335-6060
Mailing Address - Fax:
Practice Address - Street 1:840 JUNIPER CRES STE 102
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2628
Practice Address - Country:US
Practice Address - Phone:757-335-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000207176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife