1922347491 NPI number — DR. DAWN KIMBERLY PALMER PHARMD. RPH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922347491 NPI number — DR. DAWN KIMBERLY PALMER PHARMD. RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALMER
Provider First Name:
DAWN
Provider Middle Name:
KIMBERLY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD. RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOEBEL
Provider Other First Name:
DAWN
Provider Other Middle Name:
KIMBERLY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD RPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922347491
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2650 NOVATION PKWY
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53713-3399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-417-4665
Provider Business Mailing Address Fax Number:
608-327-0324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4198 NAKOOSA TRL.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53714-3399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-241-8808
Provider Business Practice Location Address Fax Number:
608-241-7882
Provider Enumeration Date:
02/04/2013

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: 183500000X , with the licence number:  12871-40 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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