Provider Demographics
NPI:1336362326
Name:PALM, MARY B (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:B
Last Name:PALM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-1312
Mailing Address - Country:US
Mailing Address - Phone:440-813-1207
Mailing Address - Fax:
Practice Address - Street 1:145 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:44047-1312
Practice Address - Country:US
Practice Address - Phone:440-813-1207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN142674163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2161226Medicare UPIN