Healthcare Provider Details

I. General information

NPI: 1578481438
Provider Name (Legal Business Name): EDYTA LAURA POLKOSNIK DNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8007 DISCOVERY DR STE A
RICHMOND VA
23229-8605
US

IV. Provider business mailing address

7202 GLEN FOREST DR STE 200
RICHMOND VA
23226-3780
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-3000
  • Fax: 804-673-2731
Mailing address:
  • Phone: 804-673-0134
  • Fax: 804-200-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024198360
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001309608
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: