Provider Demographics
NPI:1932777372
Name:PALMER, RENE VIVIAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:RENE
Middle Name:VIVIAN
Last Name:PALMER
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 1:565 W 215TH ST APT 44
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1578
Mailing Address - Country:US
Mailing Address - Phone:973-449-9480
Mailing Address - Fax:
Practice Address - Street 1:565 W 215TH ST APT 44
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1578
Practice Address - Country:US
Practice Address - Phone:973-449-9480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-13
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-302230163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty