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General NPI Number Information
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NPI Number | 1487461810
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Entity Type | Individual
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Provider Name | HEATHER DAWN POLISZUK NP
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Gender | Female
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 4660 NE BELKNAP CT STE 119
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City | HILLSBORO
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State | OR
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Zip | 97124-8402
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Country | US
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Telephone | 503-359-4773
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Fax | 503-359-3809
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Provider Business Mailing Address
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Address Line | 1909 MOUNTAIN VIEW LN STE 200
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City | FOREST GROVE
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State | OR
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Zip | 97116-2894
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Country | US
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Telephone | 33-594-7735
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Fax | 503-359-3809
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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 | 10036853
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License Number State | OR
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