Provider Demographics
NPI:1528741915
Name:PALMER, MARJORIE DIANNE (CRNP)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:DIANNE
Last Name:PALMER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11897 LYNN CREST RD
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:MD
Mailing Address - Zip Code:21770-9404
Mailing Address - Country:US
Mailing Address - Phone:301-370-3876
Mailing Address - Fax:
Practice Address - Street 1:184 THOMAS JOHNSON DR STE 201
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4562
Practice Address - Country:US
Practice Address - Phone:301-606-0551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR230961363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily