Provider Demographics
NPI:1346550035
Name:PALMER, ANDREA LACOSS (ND)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LACOSS
Last Name:PALMER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:NICOLE
Other - Last Name:LACOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:2475 W PECOS RD APT 2056
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4820
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:950 N ARIZOLA RD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-6196
Practice Address - Country:US
Practice Address - Phone:520-381-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10-1206175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath