Healthcare Provider Details

I. General information

NPI: 1447115043
Provider Name (Legal Business Name): MARY JANE POLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S PITTSBURGH ST
CONNELLSVILLE PA
15425-4403
US

IV. Provider business mailing address

140 COPE RD
PERRYOPOLIS PA
15473-1240
US

V. Phone/Fax

Practice location:
  • Phone: 724-437-0729
  • Fax:
Mailing address:
  • Phone: 724-437-0729
  • Fax: 724-437-2761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN555548
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: