Provider Demographics
NPI:1689055279
Name:DAWSON-PALMER, IRA (STNA)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:
Last Name:DAWSON-PALMER
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 E 124TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-1809
Mailing Address - Country:US
Mailing Address - Phone:216-421-6467
Mailing Address - Fax:
Practice Address - Street 1:512 E 124TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-1809
Practice Address - Country:US
Practice Address - Phone:216-421-6467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401727270215376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide