1528494531 NPI number — SHERRY NICOLE PALMER CNP

Table of content: SHERRY NICOLE PALMER CNP (NPI 1528494531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528494531 NPI number — SHERRY NICOLE PALMER CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALMER
Provider First Name:
SHERRY
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528494531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7590 AUBURN ROAD, SUITE 014
Provider Second Line Business Mailing Address:
ATTN: MED STAFF
Provider Business Mailing Address City Name:
CONCORD TWP
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44077-9176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-354-1899
Provider Business Mailing Address Fax Number:
440-354-1845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36060 EUCLID AVE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
WILLOUGHBY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44094-4656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-602-6553
Provider Business Practice Location Address Fax Number:
440-602-6566
Provider Enumeration Date:
09/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  COA.15149 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com