Healthcare Provider Details

I. General information

NPI: 1285774240
Provider Name (Legal Business Name): MARK A PALMER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 SUNSET HILL RD
WILLISTON VT
05495-9648
US

IV. Provider business mailing address

1246 SUNSET HILL RD
WILLISTON VT
05495-9648
US

V. Phone/Fax

Practice location:
  • Phone: 518-524-4811
  • Fax: 802-878-6787
Mailing address:
  • Phone: 518-524-4811
  • Fax: 802-878-6787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101-0018823
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number393924-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN281492
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number059130-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: