Healthcare Provider Details

I. General information

NPI: 1598141194
Provider Name (Legal Business Name): ANGELINE GRACE PALMER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 N ADAIR ST
CORNELIUS OR
97113-8900
US

IV. Provider business mailing address

328 W MAIN ST SUITE 300
HILLSBORO OR
97123-3967
US

V. Phone/Fax

Practice location:
  • Phone: 503-359-5564
  • Fax: 503-357-4371
Mailing address:
  • Phone: 503-352-8642
  • Fax: 503-352-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201407420NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: