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General NPI Number Information
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NPI Number | 1457084931
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Entity Type | Individual
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Provider Name | JACQUELINE INES PALMER CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/02/2022
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 30 PROSPECT AVE
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City | HACKENSACK
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State | NJ
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Zip | 07601-1915
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Country | US
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Telephone | 551-996-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 25 PARK LN S APT 3103
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City | JERSEY CITY
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State | NJ
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Zip | 07310-3146
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Country | US
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Telephone | 203-727-9418
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR20927300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 769769
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 26NJ01346900
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License Number State | NJ
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