Individual
HASKELL TRACE PALMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3401 W GORE BLVD, LAWTON, OK 73505-6332
(580) 355-8620
Mailing address
PO BOX 168, ELGIN, OK 73538-0168
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
81480
NE
367500000X
Certified Registered Nurse Anesthetist
Primary
M113074
OK
Other
Enumeration date
04/23/2019
Last updated
05/20/2019
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