Provider Demographics
NPI:1346225612
Name:PALATNIK, IRINA (NP)
Entity Type:Individual
Prefix:MRS
First Name:IRINA
Middle Name:
Last Name:PALATNIK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13380 AMIOT DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-2239
Mailing Address - Country:US
Mailing Address - Phone:314-910-1372
Mailing Address - Fax:314-542-0894
Practice Address - Street 1:13380 AMIOT DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-2239
Practice Address - Country:US
Practice Address - Phone:314-910-1372
Practice Address - Fax:314-542-0894
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO 146617363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425291309Medicaid
MOMA 4250001OtherMEDICARE
500018623OtherRAILROAD MEDICARE
500018623Medicare PIN