Provider Demographics
NPI:1407313638
Name:PALMER, DAVID GREGORY (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GREGORY
Last Name:PALMER
Suffix:
Gender:M
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 FORREST DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-2153
Mailing Address - Country:US
Mailing Address - Phone:267-808-9785
Mailing Address - Fax:
Practice Address - Street 1:123 FORREST DR
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-2153
Practice Address - Country:US
Practice Address - Phone:267-808-9785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2318755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily