Provider Demographics
NPI:1508515859
Name:PALUMBO, SAMUEL PAUL (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:PAUL
Last Name:PALUMBO
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-410-9580
Mailing Address - Fax:614-844-4589
Practice Address - Street 1:555 METRO PL N
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-5362
Practice Address - Country:US
Practice Address - Phone:614-410-9580
Practice Address - Fax:614-844-4589
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRNCNP0032142363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0005437Medicaid