Provider Demographics
NPI:1497770812
Name:PALMER, ALINA L (CNM)
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:L
Last Name:PALMER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13730 SE 119TH DR
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-7608
Mailing Address - Country:US
Mailing Address - Phone:503-260-8501
Mailing Address - Fax:360-719-2172
Practice Address - Street 1:416 NE 87TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1930
Practice Address - Country:US
Practice Address - Phone:360-719-2171
Practice Address - Fax:360-719-2172
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200550110NP-PP367A00000X
WAAP30007116367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1044459Medicaid
WA1044459Medicaid
WA1044459Medicaid