=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619493988
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEASER PALMER R.N.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2017
-----------------------------------------------------
Last Update Date | 08/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 615 LAWRENCEVILLE SUWANEE RD
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30046-4325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-330-0137
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 165 LAWRENCEVILLE/SUWANEE RD
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-452-3369
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | RN219345
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------