Provider Demographics
NPI:1750660767
Name:PALMER, MOLLY WYNN (RN, APRN)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:WYNN
Last Name:PALMER
Suffix:
Gender:F
Credentials:RN, APRN
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N HOLOPONO ST STE 108
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-6946
Mailing Address - Country:US
Mailing Address - Phone:808-206-9371
Mailing Address - Fax:
Practice Address - Street 1:1300 N HOLOPONO ST STE 108
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-6946
Practice Address - Country:US
Practice Address - Phone:808-206-9371
Practice Address - Fax:855-270-7441
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201042900RN163WP0808X
HIRN 72499163WP0808X
OR201250111 NP363LP0808X
HIAPRN 1492363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health