Healthcare Provider Details

I. General information

NPI: 1598173411
Provider Name (Legal Business Name): DANIELLE M PALMER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 SOUTHGATE PKWY
CAMBRIDGE OH
43725-3024
US

IV. Provider business mailing address

24 HOMESTEAD AVE
WHEELING WV
26003-6638
US

V. Phone/Fax

Practice location:
  • Phone: 740-432-3634
  • Fax: 740-432-7135
Mailing address:
  • Phone: 304-232-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.1404-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN72869-FNP-BC
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: