Doctor Name: | MAUREEN STANEK POLAKOWSKI |
NPI Number: | 1023011210 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CRNP |
License Number: | VP004369B |
Business Practice Address: | 7 Dock Hill Rd Middleburg, PA - 178428910 |
Business Phone Number: | 5708372123 |
Business Fax Number: | 5708372185 |
Mailing Address: | 699 Hastings St, SOUTH WILLIAMSPORT |
State: | PA |
Postal Code: | 177027606 |
Phone Number: | 5703271665 |
Fax Number: | 5703217800 |
NPI Enumeration Date: | 05/23/2005 |
NPI Last Update Date: | 12/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | VP004369B |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |