Healthcare Provider Details

I. General information

NPI: 1740569268
Provider Name (Legal Business Name): JONATHAN RHIEN PALMER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S SCHWARTZ AVE STE 102
FARMINGTON NM
87401-5925
US

IV. Provider business mailing address

407 S SCHWARTZ AVE STE 102
FARMINGTON NM
87401-5925
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-6700
  • Fax:
Mailing address:
  • Phone: 505-609-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-01821
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: