Provider Demographics
NPI:1013284975
Name:PALMER, JUDY LEE (ANP)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:LEE
Last Name:PALMER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 BROADWAY ST NE STE 300
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1761
Mailing Address - Country:US
Mailing Address - Phone:763-587-7737
Mailing Address - Fax:763-578-7069
Practice Address - Street 1:3433 BROADWAY ST NE STE 300
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1761
Practice Address - Country:US
Practice Address - Phone:763-587-7737
Practice Address - Fax:763-578-7069
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2531363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health