Provider Demographics
NPI:1346713823
Name:PALMER, MARA (HAIRLOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:HAIRLOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 E TITUS ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-5906
Mailing Address - Country:US
Mailing Address - Phone:206-659-1969
Mailing Address - Fax:
Practice Address - Street 1:351 STRANDER BLVD # 36
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2916
Practice Address - Country:US
Practice Address - Phone:206-659-1969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty