Healthcare Provider Details

I. General information

NPI: 1700867058
Provider Name (Legal Business Name): JOYCE M MCMAHON PALMATEER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S RACE ST
MISHAWAKA IN
46544-2032
US

IV. Provider business mailing address

210 S RACE ST
MISHAWAKA IN
46544-2032
US

V. Phone/Fax

Practice location:
  • Phone: 574-404-6755
  • Fax: 833-783-4269
Mailing address:
  • Phone: 574-404-6755
  • Fax: 833-783-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28156667A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001654A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: