1700185287 NPI number — MRS. KAREN MARIE PALMER RD,LD,CDE

Table of content: MRS. KAREN MARIE PALMER RD,LD,CDE (NPI 1700185287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700185287 NPI number — MRS. KAREN MARIE PALMER RD,LD,CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALMER
Provider First Name:
KAREN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD,LD,CDE
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:
1700185287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3435 WEST BROADWAY AVE
Provider Second Line Business Mailing Address:
NORTH MEMORIAL OUTPATIENT CENTER
Provider Business Mailing Address City Name:
ROBBINSDALE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-520-5489
Provider Business Mailing Address Fax Number:
763-520-1133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3435 W BROADWAY AVE
Provider Second Line Business Practice Location Address:
NORTH MEMORIAL OUTPATIENT CENTER
Provider Business Practice Location Address City Name:
ROBBINSDALE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55422-2969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-520-5489
Provider Business Practice Location Address Fax Number:
763-520-1133
Provider Enumeration Date:
03/23/2011

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: 133V00000X , with the licence number:  1843 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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