MEDICARE: CHARLENE Y PALMER RN

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	163W00000X	Registered Nurse	680744	TX

General Provider Information

NPI Number	:	1194904623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE Y PALMER RN

Provider Business Mailing Address
First Line	:	301 UNIVERSITY BLVD
Second Line	:	PROVIDER ENROLLMENT -- RT. 1022
City	:	GALVESTON
State	:	TX
Zip	:	77555-5302
Country	:	US
Telephone Number	:	409-747-0890
Fax Number	:	409-747-1023

Provider Business Practice Location Address
First Line	:	5819 10TH ST
Second Line	:	STE A
City	:	KATY
State	:	TX
Zip	:	77493-1636
Country	:	US
Telephone Number	:	281-391-7001
Fax Number	:

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

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	11/01/2007

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