Healthcare Provider Details

I. General information

NPI: 1265245567
Provider Name (Legal Business Name): EMILY ROSE PALMER RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N STATE ST STE 305
GREENFIELD IN
46140-1270
US

IV. Provider business mailing address

6429 BLAKEVIEW DR
INDIANAPOLIS IN
46235-8139
US

V. Phone/Fax

Practice location:
  • Phone: 317-477-6363
  • Fax: 317-477-6366
Mailing address:
  • Phone: 812-241-5948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number28274644A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: