Provider Demographics
NPI:1487353694
Name:PALMER, SAMUEL JAY (RN)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JAY
Last Name:PALMER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:HEPPNER
Mailing Address - State:OR
Mailing Address - Zip Code:97836-0469
Mailing Address - Country:US
Mailing Address - Phone:541-676-9161
Mailing Address - Fax:541-676-5662
Practice Address - Street 1:528 E MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:JOHN DAY
Practice Address - State:OR
Practice Address - Zip Code:97845-1289
Practice Address - Country:US
Practice Address - Phone:541-575-3604
Practice Address - Fax:541-575-0429
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR087000613RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse