Provider Demographics
NPI:1023769056
Name:PALMAR, LADEANE MARIE (LMP)
Entity type:Individual
Prefix:
First Name:LADEANE
Middle Name:MARIE
Last Name:PALMAR
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:CEDAR
Other - Middle Name:SKY
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3119 E 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-7162
Mailing Address - Country:US
Mailing Address - Phone:760-566-5567
Mailing Address - Fax:
Practice Address - Street 1:100 N MULLAN RD STE 103
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6848
Practice Address - Country:US
Practice Address - Phone:509-777-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61243042225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty