| Doctor Name: | ANDREA NICOLE POLSON |
| NPI Number: | 1225338627 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 0084059 |
| Business Practice Address: | Us Highway 56 & 270 Junction Barking Water Road Wewoka, OK - 748841475 |
| Business Phone Number: | 4052576282 |
| Business Fax Number: | 4052573344 |
| Mailing Address: | P.o. Box 1475, Barking Water Road WEWOKA |
| State: | OK |
| Postal Code: | 748841475 |
| Phone Number: | 4052576282 |
| Fax Number: | 4052573344 |
| NPI Enumeration Date: | 11/01/2010 |
| NPI Last Update Date: | 11/01/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WG0000X |
| License Number: | 0084059 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OK |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | General Practice |
| Taxonomy Definition: | |