Provider Demographics
NPI:1972777647
Name:PALMER, JODI L (STNA)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:PALMER
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 HENRY AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-2851
Mailing Address - Country:US
Mailing Address - Phone:330-455-4618
Mailing Address - Fax:
Practice Address - Street 1:1507 HENRY AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-2851
Practice Address - Country:US
Practice Address - Phone:330-455-4618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide