Healthcare Provider Details

I. General information

NPI: 1649543422
Provider Name (Legal Business Name): URENENA HORTON POLK RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 WILLMON WAY
SAN ANTONIO TX
78239-1948
US

IV. Provider business mailing address

8915 WILLMON WAY
SAN ANTONIO TX
78239-1948
US

V. Phone/Fax

Practice location:
  • Phone: 210-725-9682
  • Fax:
Mailing address:
  • Phone: 210-725-9682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number521996
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number521996
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number521996
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number521996
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number521996
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: