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General NPI Number Information
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NPI Number | 1093393951
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Entity Type | Individual
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Provider Name | ANDREA MARIE POLO FNP
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Gender | Female
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 11/23/2024
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Provider Practice Location Address
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Address Line | 6035 SE MILWAUKIE AVE
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City | PORTLAND
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State | OR
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Zip | 97202-5344
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Country | US
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Telephone | 971-258-1120
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Fax | 866-309-2838
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Provider Business Mailing Address
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Address Line | 738 BANCROFT RD
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City | WALNUT CREEK
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State | CA
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Zip | 94598-1531
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Country | US
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Telephone | 866-389-2727
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP61614580
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 10031339
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95016674
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License Number State | CA
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