Provider Demographics
NPI:1952934895
Name:PALMER, LEA (RDN)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22835 GLACIER VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9560
Mailing Address - Country:US
Mailing Address - Phone:480-343-0247
Mailing Address - Fax:
Practice Address - Street 1:22835 GLACIER VIEW DR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-9560
Practice Address - Country:US
Practice Address - Phone:480-343-0247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK151247133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered