Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | R212152 | MD |
NPI | 1023610144 |
---|---|
Provider Name | Immaculata Palmer |
First Address | Baltimore, MD 21206-2236 |
Second Address | Baltimore, MD 21201-1544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2020 |
Last Update Date | 23/11/2020 |