Healthcare Provider Details

I. General information

NPI: 1194117432
Provider Name (Legal Business Name): HARLEE PALMER MPAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10502 PARK RD SUITE 100
CHARLOTTE NC
28210-8479
US

IV. Provider business mailing address

10502 PARK RD SUITE 100
CHARLOTTE NC
28210-8479
US

V. Phone/Fax

Practice location:
  • Phone: 704-541-9092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-05456
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: