Healthcare Provider Details

I. General information

NPI: 1497255137
Provider Name (Legal Business Name): CASEY POLCARI AUD CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 N ROXBORO ST
DURHAM NC
27704-2122
US

IV. Provider business mailing address

4102 N ROXBORO ST
DURHAM NC
27704-2122
US

V. Phone/Fax

Practice location:
  • Phone: 919-595-2106
  • Fax: 919-595-2190
Mailing address:
  • Phone: 919-595-2106
  • Fax: 919-595-2190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number11724
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: