Provider Demographics
NPI:1073336400
Name:PALMER, LACY (RN)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:235 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-2314
Mailing Address - Country:US
Mailing Address - Phone:218-240-8225
Mailing Address - Fax:218-373-0269
Practice Address - Street 1:235 4TH AVE
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2314
Practice Address - Country:US
Practice Address - Phone:218-240-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2491263163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health