Healthcare Provider Details

I. General information

NPI: 1891263927
Provider Name (Legal Business Name): JENA CHRISTINE PALMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 E WASHINGTON STREET
MEDINA OH
44256
US

IV. Provider business mailing address

2671 DEER TRL
NILES OH
44446-4472
US

V. Phone/Fax

Practice location:
  • Phone: 330-536-3746
  • Fax:
Mailing address:
  • Phone: 330-978-7390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.023336
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: