Provider Demographics
NPI:1922243955
Name:PALMER, ROBERT VERDELL (RN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:VERDELL
Last Name:PALMER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 EDMONDS CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-8465
Mailing Address - Country:US
Mailing Address - Phone:573-474-0270
Mailing Address - Fax:
Practice Address - Street 1:2401 EDMONDS CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-8465
Practice Address - Country:US
Practice Address - Phone:573-474-0270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities