Provider Demographics
NPI:1154411957
Name:PALMER, LAURI A (MD)
Entity type:Individual
Prefix:MRS
First Name:LAURI
Middle Name:A
Last Name:PALMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 BRICE STREET
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-3505
Mailing Address - Country:US
Mailing Address - Phone:307-322-3861
Mailing Address - Fax:307-322-2018
Practice Address - Street 1:1551 BRICE STREET
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-3505
Practice Address - Country:US
Practice Address - Phone:307-322-3861
Practice Address - Fax:307-322-2018
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5657A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY306981Medicare ID - Type Unspecified
WYF68275Medicare UPIN