Healthcare Provider Details

I. General information

NPI: 1871945139
Provider Name (Legal Business Name): DENISE L POLAND APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5212 3RD AVE
KEARNEY NE
68845-2831
US

IV. Provider business mailing address

5212 3RD AVE
KEARNEY NE
68845-2831
US

V. Phone/Fax

Practice location:
  • Phone: 800-253-4368
  • Fax:
Mailing address:
  • Phone: 800-253-4368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number112031
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: