Healthcare Provider Details

I. General information

NPI: 1710349212
Provider Name (Legal Business Name): MRS. NICOLE MAREE PALMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ANDREWS ST
MITCHELL SD
57301-4703
US

IV. Provider business mailing address

105 ANDREWS ST
MITCHELL SD
57301-4703
US

V. Phone/Fax

Practice location:
  • Phone: 605-995-0808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: