MEDICARE: ERIC L. 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	146D00000X	Personal Emergency Response Attendant	LCSW 5036-C	NV

General Provider Information

NPI Number	:	1619414281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC L. PALMER

Provider Business Mailing Address
First Line	:	6324 FAIRWOOD AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2568
Country	:	US
Telephone Number	:	702-321-5982
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 S RAINBOW BLVD STE 145
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6208
Country	:	US
Telephone Number	:	702-561-7896
Fax Number	:

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

Provider Enumeration Date	:	01/20/2017
Last Update Date	:	01/20/2017

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