Provider Demographics
NPI:1306012505
Name:PALMER, MICHELE RENEE (LD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:RENEE
Last Name:PALMER
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:RENEE
Other - Last Name:FALKENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LD
Mailing Address - Street 1:1153 E GANNON DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2611
Mailing Address - Country:US
Mailing Address - Phone:314-520-2233
Mailing Address - Fax:636-931-2177
Practice Address - Street 1:1153 E GANNON DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2611
Practice Address - Country:US
Practice Address - Phone:314-520-2233
Practice Address - Fax:636-931-2177
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education