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General NPI Number Information
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NPI Number | 1265184642
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Entity Type | Individual
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Provider Name | EMILY GRACE POLHAMUS APRN
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Gender | Female
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Dates
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Enumeration Date | 01/26/2022
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 919 JR HIGH SCHOOL RD
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City | SCOTLAND NECK
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State | NC
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Zip | 27874-1219
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Country | US
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Telephone | 252-826-3143
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Fax | 252-826-3110
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Provider Business Mailing Address
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Address Line | PO BOX 640
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City | ROANOKE RAPIDS
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State | NC
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Zip | 27870-0640
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Country | US
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Telephone | 252-536-5844
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Fax | 252-519-0154
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5021138
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11016854
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License Number State | FL
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