Provider Demographics
NPI:1730549460
Name:PALMER, JANICE (LPN)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 OF LANIER RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:GA
Mailing Address - Zip Code:31321-5606
Mailing Address - Country:US
Mailing Address - Phone:912-704-4585
Mailing Address - Fax:
Practice Address - Street 1:255 OF LANIER RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:GA
Practice Address - Zip Code:31321-5606
Practice Address - Country:US
Practice Address - Phone:912-704-4585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN038509164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse