Provider Demographics
NPI:1770302812
Name:PALME, VICTORIA ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ROSE
Last Name:PALME
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2179 4TH ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3041
Mailing Address - Country:US
Mailing Address - Phone:651-381-1521
Mailing Address - Fax:
Practice Address - Street 1:2179 4TH ST STE 2B
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3041
Practice Address - Country:US
Practice Address - Phone:651-381-1521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15139363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant