Provider Demographics
NPI:1396840658
Name:PALME, PAMELA SUE (CRNA,MSN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:PALME
Suffix:
Gender:F
Credentials:CRNA,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 KATHY LN
Mailing Address - Street 2:
Mailing Address - City:NEW BADEN
Mailing Address - State:IL
Mailing Address - Zip Code:62265-2025
Mailing Address - Country:US
Mailing Address - Phone:618-910-3104
Mailing Address - Fax:
Practice Address - Street 1:9515 HOLY CROSS LN
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-3618
Practice Address - Country:US
Practice Address - Phone:618-526-5329
Practice Address - Fax:618-526-2291
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041314944367500000X
IL209004248367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL558390Medicare ID - Type Unspecified