Provider Demographics
NPI:1568899524
Name:KECKES-PALMER, NICOLAJ PETER
Entity Type:Individual
Prefix:MR
First Name:NICOLAJ
Middle Name:PETER
Last Name:KECKES-PALMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 MILBANKE DR SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-7723
Mailing Address - Country:US
Mailing Address - Phone:360-485-5640
Mailing Address - Fax:
Practice Address - Street 1:1144 MILBANKE DR SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-7723
Practice Address - Country:US
Practice Address - Phone:360-485-5640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60336601171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor