Basic Information
Provider Information
NPI: 1568864841
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PALMER
FirstName: CHRIS
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 203 N WASHINGTON ST
Address2: STE 300
City: SPOKANE
State: WA
PostalCode: 992010233
CountryCode: US
TelephoneNumber: 5094448888
FaxNumber: 5094447806
Practice Location
Address1: 15812 E INDIANA AVE
Address2:  
City: SPOKANE VALLEY
State: WA
PostalCode: 992161875
CountryCode: US
TelephoneNumber: 5094448200
FaxNumber: 5094448206
Other Information
ProviderEnumerationDate: 09/18/2014
LastUpdateDate: 02/10/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XPA 60586781WAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


Home