Provider Demographics
NPI:1609239375
Name:PALMER, GREGG V (LPN)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:V
Last Name:PALMER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4948 BALUSTRADE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-4168
Mailing Address - Country:US
Mailing Address - Phone:801-550-7633
Mailing Address - Fax:
Practice Address - Street 1:17TH AND C STREET
Practice Address - Street 2:BLDG 11582
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431
Practice Address - Country:US
Practice Address - Phone:253-966-7647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN210175164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse