Healthcare Provider Details

I. General information

NPI: 1316471691
Provider Name (Legal Business Name): LAURA JEAN PALMER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PETRIE ST
LITTLE FALLS NY
13365-1610
US

IV. Provider business mailing address

15 PETRIE ST
LITTLE FALLS NY
13365-1610
US

V. Phone/Fax

Practice location:
  • Phone: 315-823-2280
  • Fax: 315-823-4407
Mailing address:
  • Phone: 315-823-2280
  • Fax: 315-823-4407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number3961751
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: