Provider Demographics
NPI:1790332112
Name:PALMER, PATRICIA A
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
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 1:181 EDGEWOOD
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:TX
Mailing Address - Zip Code:77360-7712
Mailing Address - Country:US
Mailing Address - Phone:936-329-2250
Mailing Address - Fax:
Practice Address - Street 1:181 EDGEWOOD
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:TX
Practice Address - Zip Code:77360-7712
Practice Address - Country:US
Practice Address - Phone:936-329-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider