MEDICARE: DARLENE POLK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-24-358271	CO

General Provider Information

NPI Number	:	1164255071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLENE POLK

Provider Business Mailing Address
First Line	:	2433 SOTHMAN DR
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68801-7260
Country	:	US
Telephone Number	:	308-675-0682
Fax Number	:

Provider Business Practice Location Address
First Line	:	2433 SOTHMAN DR
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68801-7260
Country	:	US
Telephone Number	:	308-675-0682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	08/26/2024

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Directions to “ DARLENE POLK ” Practice Location

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