Provider Demographics
NPI:1023168002
Name:PALM, CAROL JOAN (RN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:JOAN
Last Name:PALM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:JOAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1019 HERMAN PL
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1802
Mailing Address - Country:US
Mailing Address - Phone:303-772-3084
Mailing Address - Fax:
Practice Address - Street 1:2515 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4110
Practice Address - Country:US
Practice Address - Phone:303-245-0894
Practice Address - Fax:303-245-0916
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84137163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health