Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 1716711 | WI |
NPI | 1538736350 |
---|---|
Provider Name | Theresa L Palmen |
First Address | Waterford, WI 53185-4128 |
Second Address | Waukesha, WI 53188-5031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2021 |
Last Update Date | 09/06/2021 |