Healthcare Provider Details

I. General information

NPI: 1114449451
Provider Name (Legal Business Name): NANCY I POLASHUK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W JACKSON ST
SPRING GROVE PA
17362-1114
US

IV. Provider business mailing address

1916 ROSEPOINTE WAY
SPRING GROVE PA
17362-8947
US

V. Phone/Fax

Practice location:
  • Phone: 717-703-0990
  • Fax: 877-409-3567
Mailing address:
  • Phone: 717-683-5579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA004189
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA059135
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: