Provider Demographics
NPI:1376902437
Name:PALMER, RENEE (APRN, CNP)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8181 N CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8752
Mailing Address - Country:US
Mailing Address - Phone:208-772-0785
Mailing Address - Fax:208-762-2704
Practice Address - Street 1:8181 N CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:HAYDEN LAKE
Practice Address - State:ID
Practice Address - Zip Code:83835-8752
Practice Address - Country:US
Practice Address - Phone:208-772-0785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1704A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily