Healthcare Provider Details

I. General information

NPI: 1184683500
Provider Name (Legal Business Name): MARY ELIZABETH POLSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MARY ELIZABETH SKOWRONEK CRNP

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 LINGLESTOWN RD
HARRISBURG PA
17110
US

IV. Provider business mailing address

2151 LINGLESTOWN RD
HARRISBURG PA
17110
US

V. Phone/Fax

Practice location:
  • Phone: 717-545-4786
  • Fax: 717-545-6359
Mailing address:
  • Phone: 717-545-4786
  • Fax: 717-545-6359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP003053C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: