Provider Demographics
NPI:1598141194
Name:PALMER, ANGELINE GRACE (NP)
Entity Type:Individual
Prefix:
First Name:ANGELINE
Middle Name:GRACE
Last Name:PALMER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 W MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-3967
Mailing Address - Country:US
Mailing Address - Phone:503-352-8642
Mailing Address - Fax:503-352-8658
Practice Address - Street 1:1151 N ADAIR ST
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:OR
Practice Address - Zip Code:97113-8900
Practice Address - Country:US
Practice Address - Phone:503-359-5564
Practice Address - Fax:503-357-4371
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201407420NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201407420NP-PPOtherOR LICENSE