Provider Demographics
NPI:1134739741
Name:PALMER, CHALONDA (NURSE)
Entity type:Individual
Prefix:
First Name:CHALONDA
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N ROSEVERE AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1742
Mailing Address - Country:US
Mailing Address - Phone:248-508-3024
Mailing Address - Fax:
Practice Address - Street 1:800 N ROSEVERE AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1742
Practice Address - Country:US
Practice Address - Phone:248-508-3024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703119103164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse