MEDICARE: JANAEL PALMER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	R202962	MD
2	363LP2300X	Primary Care Nurse Practitioner	R202962	MD
3	363LC1500X	Community Health Nurse Practitioner	R202962	MD
4	363LG0600X	Gerontology Nurse Practitioner	R202962	MD
5	363L00000X	Nurse Practitioner	R202962	MD

General Provider Information

NPI Number	:	1073290854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANAEL PALMER NP

Provider Business Mailing Address
First Line	:	4410 74TH AVE
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-2222
Country	:	US
Telephone Number	:	240-906-9462
Fax Number	:

Provider Business Practice Location Address
First Line	:	4410 74TH AVE
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-2222
Country	:	US
Telephone Number	:	240-906-9462
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	11/02/2024

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