Provider Demographics
NPI:1538148051
Name:PALM, LORRI CHERIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LORRI
Middle Name:CHERIE
Last Name:PALM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:L.
Other - Middle Name:CHERIE
Other - Last Name:PALM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 861
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501
Mailing Address - Country:US
Mailing Address - Phone:435-636-0486
Mailing Address - Fax:
Practice Address - Street 1:436 5TH & TED STEVENS WAY
Practice Address - Street 2:
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752-0043
Practice Address - Country:US
Practice Address - Phone:907-442-3321
Practice Address - Fax:907-442-7250
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA1479363A00000X
NY004730-1363A00000X
IN10000252A363A00000X
GA003343363A00000X
NC103016363A00000X
MI56010003324363A00000X
UT332788-1206363A00000X
AK905363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHS19IPMedicaid
AKHS19OPMedicaid
AK021310Medicare Oscar/Certification
AKTEZ042Medicare PIN