Healthcare Provider Details

I. General information

NPI: 1265721237
Provider Name (Legal Business Name): SANDRA ANN POLACHEK FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA ANN LOPEZ KEMERLING

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1459
MINNEAPOLIS MN
55440-1459
US

IV. Provider business mailing address

4413 APPLETREE CT
SAINT JOSEPH MO
64506-3697
US

V. Phone/Fax

Practice location:
  • Phone: 800-328-5979
  • Fax:
Mailing address:
  • Phone: 816-390-3273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2005011210
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2011008776
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: