Provider Demographics
NPI:1770957656
Name:PALMER LUETHE, CAROLYN (LAC, RN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:PALMER LUETHE
Suffix:
Gender:F
Credentials:LAC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MAIN ST
Mailing Address - Street 2:SUITE C2
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-5469
Mailing Address - Country:US
Mailing Address - Phone:458-201-7952
Mailing Address - Fax:
Practice Address - Street 1:500 MAIN ST
Practice Address - Street 2:SUITE C2
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-5469
Practice Address - Country:US
Practice Address - Phone:458-201-7952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR092007306RN163W00000X
ORAC175155171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse