Provider Demographics
NPI:1144316373
Name:PALMER, JAMES S (NP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:PALMER
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:1722 SHAFFER STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048
Mailing Address - Country:US
Mailing Address - Phone:269-381-3963
Mailing Address - Fax:269-381-3215
Practice Address - Street 1:1722 SHAFFER STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048
Practice Address - Country:US
Practice Address - Phone:269-381-3963
Practice Address - Fax:269-381-3215
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704232568363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION41240Medicare ID - Type Unspecified