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NPI Code Detail

MEDICARE: IAN RAY PALMEJAR FNP

MEDICARE: IAN RAY PALMEJAR FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerF05220729MO

General Provider Information

NPI Number : 1154059061
Entity Type Code : Individual
Provider Name (Legal Business Name) : IAN RAY PALMEJAR FNP
Provider Business Mailing Address
First Line : 9969 TESSON CREEK ESTATES DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63123-6298
Country : US
Telephone Number : 314-757-2338
Fax Number :
Provider Business Practice Location Address
First Line : 536 N TAYLOR AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63108-1888
Country : US
Telephone Number : 314-449-1143
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2022
Last Update Date : 08/09/2022

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