MEDICARE: MISS JOSY DANIELLE PALMER

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	390200000X	Student in an Organized Health Care Education/Training Program		NC

General Provider Information

NPI Number	:	1548973597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JOSY DANIELLE PALMER

Provider Business Mailing Address
First Line	:	2635 JUNE JOHNSON RD
Second Line	:
City	:	RAEFORD
State	:	NC
Zip	:	28376-8117
Country	:	US
Telephone Number	:	910-605-6211
Fax Number	:

Provider Business Practice Location Address
First Line	:	2635 JUNE JOHNSON RD
Second Line	:
City	:	RAEFORD
State	:	NC
Zip	:	28376-8117
Country	:	US
Telephone Number	:	910-605-6211
Fax Number	:

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

Provider Enumeration Date	:	01/04/2023
Last Update Date	:	01/04/2023

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Directions to “ MISS JOSY DANIELLE PALMER ” Practice Location

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