Provider Demographics
NPI:1417517665
Name:PALMER, LATROSHIA MAREE
Entity Type:Individual
Prefix:
First Name:LATROSHIA
Middle Name:MAREE
Last Name:PALMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 BELLEMONT RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-8542
Mailing Address - Country:US
Mailing Address - Phone:252-432-6597
Mailing Address - Fax:
Practice Address - Street 1:75 FREEDOM PKWY STE C
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-4939
Practice Address - Country:US
Practice Address - Phone:919-545-0911
Practice Address - Fax:919-545-0096
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF06191063363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily