Healthcare Provider Details

I. General information

NPI: 1902948540
Provider Name (Legal Business Name): PEARL LEE PALMER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11279 W GRIER RD
MARANA AZ
85653-9609
US

IV. Provider business mailing address

9210 N CAMINO DE LA TIERRA
TUCSON AZ
85742-9000
US

V. Phone/Fax

Practice location:
  • Phone: 520-682-4782
  • Fax: 520-682-4818
Mailing address:
  • Phone: 520-572-8206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN092689
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: