Provider Demographics
NPI:1053565945
Name:PLUMLEY, JACKIE LYNN (LPN)
Entity type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:LYNN
Last Name:PLUMLEY
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 1:42858 W KRISTAL LN
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85238-5888
Mailing Address - Country:US
Mailing Address - Phone:520-423-9002
Mailing Address - Fax:
Practice Address - Street 1:45012 W HONEYCUTT AVE
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85239-2842
Practice Address - Country:US
Practice Address - Phone:520-840-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP043604164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse