Provider Demographics
NPI:1881105427
Name:PLUMMER- EDWARDS, EUGENNIE (ANP)
Entity type:Individual
Prefix:MRS
First Name:EUGENNIE
Middle Name:
Last Name:PLUMMER- EDWARDS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MRS
Other - First Name:EUGENNIE
Other - Middle Name:
Other - Last Name:PLUMMER-EDWARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP
Mailing Address - Street 1:902 47TH ST APT RB5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2819
Mailing Address - Country:US
Mailing Address - Phone:718-781-8206
Mailing Address - Fax:
Practice Address - Street 1:17 N PLANK RD STE 10
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2111
Practice Address - Country:US
Practice Address - Phone:845-800-9305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA531506-1364SA2200X
NYF3080531363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Single Specialty