Provider Demographics
NPI:1730679101
Name:PALMA, VERONICA (AT STUDENT)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:PALMA
Suffix:
Gender:F
Credentials:AT STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S PROSPECT AVE UNIT 206
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5645
Mailing Address - Country:US
Mailing Address - Phone:630-544-4883
Mailing Address - Fax:
Practice Address - Street 1:1430 MONROE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2051
Practice Address - Country:US
Practice Address - Phone:608-265-2503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program