Provider Demographics
NPI:1922504398
Name:PALMORE, DWANDA RENEE
Entity Type:Individual
Prefix:
First Name:DWANDA
Middle Name:RENEE
Last Name:PALMORE
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 1:115 MONTARA DR
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-5019
Mailing Address - Country:US
Mailing Address - Phone:813-540-1091
Mailing Address - Fax:
Practice Address - Street 1:115 MONTARA DR
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-5019
Practice Address - Country:US
Practice Address - Phone:813-540-1091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management