Basic Information
| Provider Information | |||||||||
| NPI: | 1902850761 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALMER | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | T. | ||||||||
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| Credential: | MSN, CNS, APN ED.M, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2250 CHAPEL AVE W | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080022051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564829000 | ||||||||
| FaxNumber: | 8564821159 | ||||||||
| Practice Location | |||||||||
| Address1: | 2250 CHAPEL AVE W | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080022051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564829000 | ||||||||
| FaxNumber: | 8564821159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 03/09/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0809X | NJ00012600 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
ID Information
| ID | Type | State | Issuer | Description | 7586776 | 01 | NJ | AETNA HMO | OTHER | 2280944 | 01 | NJ | CIGNA BH | OTHER | 0103888 | 05 | NJ | MEDICAID |