Provider Demographics
NPI:1427632231
Name:PALMER, SHANIQUE MARIE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:SHANIQUE
Middle Name:MARIE
Last Name:PALMER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 DYBERRY PL APT 2
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-2065
Mailing Address - Country:US
Mailing Address - Phone:570-442-2023
Mailing Address - Fax:
Practice Address - Street 1:1227 DYBERRY PL APT 2
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-2065
Practice Address - Country:US
Practice Address - Phone:570-442-2023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY762829163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse