Provider Demographics
NPI:1457303067
Name:PALM, DAVID A (APN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:PALM
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENNEPIN COUNTY MEDICAL CENTER
Mailing Address - Street 2:701 PARK AVE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415
Mailing Address - Country:US
Mailing Address - Phone:612-873-3000
Mailing Address - Fax:612-904-4477
Practice Address - Street 1:HENNEPIN COUNTY MEDICAL CENTER
Practice Address - Street 2:701 PARK AVE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415
Practice Address - Country:US
Practice Address - Phone:612-873-3000
Practice Address - Fax:612-904-4477
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN199476-2363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204914001Medicaid
TXP92160Medicare UPIN
TX8J3132Medicare PIN