Healthcare Provider Details

I. General information

NPI: 1053779124
Provider Name (Legal Business Name): AMY POLING MSN ED., RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4475 S HAMILTON RD
GROVEPORT OH
43125-9333
US

IV. Provider business mailing address

4475 S HAMILTON RD
GROVEPORT OH
43125-9333
US

V. Phone/Fax

Practice location:
  • Phone: 614-836-4964
  • Fax:
Mailing address:
  • Phone: 614-836-4964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN.318087
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.318087
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: