Provider Demographics
NPI:1053559286
Name:PALMER, SANDRA JEAN (APRN)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JEAN
Last Name:PALMER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 ROOSEVELT HWY
Mailing Address - Street 2:BOX 283
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-7233
Mailing Address - Country:US
Mailing Address - Phone:802-879-6406
Mailing Address - Fax:
Practice Address - Street 1:2032 ROOSEVELT HWY
Practice Address - Street 2:BOX 283
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-7233
Practice Address - Country:US
Practice Address - Phone:802-879-6406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0011263363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
04288510OtherCIGNA
VTONP 1617Medicaid
LLV398OtherMVP
38169OtherBCBS
ANP 1617OtherMEDICARE