Healthcare Provider Details

I. General information

NPI: 1386744753
Provider Name (Legal Business Name): KAREN A POLENSKY MS, RD/LDN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 NORLAND AVE STE 204
CHAMBERSBURG PA
17201-4231
US

IV. Provider business mailing address

52 PINE CREEK DR
CARLISLE PA
17013-9668
US

V. Phone/Fax

Practice location:
  • Phone: 717-217-6820
  • Fax:
Mailing address:
  • Phone: 717-609-3537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN003369
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: