Provider Demographics
NPI:1548592058
Name:PALMER, ELIZABETH RENEE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:RENEE
Last Name:PALMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S BERETANIA ST
Mailing Address - Street 2:SUITE 603
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2414
Mailing Address - Country:US
Mailing Address - Phone:303-550-6852
Mailing Address - Fax:
Practice Address - Street 1:550 S BERETANIA ST
Practice Address - Street 2:SUITE 603
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2414
Practice Address - Country:US
Practice Address - Phone:303-550-6852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20486363A00000X
HIAMD-375363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000294017OtherHMSA
HI042155959OtherUHA