Provider Demographics
NPI:1609399120
Name:PALKERT-DAWES, LISA (PMHNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PALKERT-DAWES
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-3908
Mailing Address - Country:US
Mailing Address - Phone:607-242-9460
Mailing Address - Fax:
Practice Address - Street 1:59 RIVER ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1035
Practice Address - Country:US
Practice Address - Phone:607-547-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402213363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health