Healthcare Provider Details

I. General information

NPI: 1164567517
Provider Name (Legal Business Name): MARTI JO PALMER RNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 HIGHLAND AVE
SALEM MA
01970-2141
US

IV. Provider business mailing address

901 MAIN ST
WEST NEWBURY MA
01985-1301
US

V. Phone/Fax

Practice location:
  • Phone: 978-741-1200
  • Fax: 978-740-4902
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number217858
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: