Provider Demographics
NPI:1023330438
Name:PALMER, MICHAELLE SUZANNE (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:MICHAELLE
Middle Name:SUZANNE
Last Name:PALMER
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:MICHAELLE
Other - Middle Name:SUZANNE
Other - Last Name:SCHIMMOELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5400 FRANTZ RD
Mailing Address - Street 2:STE 250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-6102
Mailing Address - Country:US
Mailing Address - Phone:614-544-6155
Mailing Address - Fax:
Practice Address - Street 1:915 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 2100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3153
Practice Address - Country:US
Practice Address - Phone:614-293-8566
Practice Address - Fax:614-293-3381
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002711363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0081964Medicaid
OH0081964Medicaid