Healthcare Provider Details

I. General information

NPI: 1447577820
Provider Name (Legal Business Name): BRENDA L. POLACHEK FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 N BELT HWY
SAINT JOSEPH MO
64506-1299
US

IV. Provider business mailing address

4201 N BELT HWY
SAINT JOSEPH MO
64506-1299
US

V. Phone/Fax

Practice location:
  • Phone: 816-749-4444
  • Fax: 816-749-4446
Mailing address:
  • Phone: 816-749-4444
  • Fax: 816-749-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number134300
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: