Provider Demographics
NPI:1508909060
Name:PALMER, JOAN MARIE (PAC)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:MARIE
Last Name:PALMER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 359766
Mailing Address - Street 2:325 NINTH AVENUE
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2420
Mailing Address - Country:US
Mailing Address - Phone:206-744-9300
Mailing Address - Fax:206-744-9943
Practice Address - Street 1:325 NINTH AVENUE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-744-9300
Practice Address - Fax:206-744-9943
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2012-07-03
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-02-21
Provider Licenses
StateLicense IDTaxonomies
WAHC00148579363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
295790OtherINTERNAL ID-MOTOR VEHICLE ID
WA8325755Medicaid
AB33172Medicare ID - Type Unspecified
WA8325755Medicaid