Provider Demographics
NPI:1609242676
Name:PALMER, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48380 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-6458
Mailing Address - Country:US
Mailing Address - Phone:907-395-0515
Mailing Address - Fax:
Practice Address - Street 1:605 MARINE AVE
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-6928
Practice Address - Country:US
Practice Address - Phone:907-283-4875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1006124Q00000X
CARDH17970124Q00000X
CA572125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist
No124Q00000XDental ProvidersDental Hygienist