=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518671585
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | POLIXENI CHIRGOTT RN, BSN, APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2023
-----------------------------------------------------
Last Update Date | 01/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 W WESTERN RESERVE RD STE B
-----------------------------------------------------
City | POLAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44514-3522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-423-2114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 SUMMITT ST
-----------------------------------------------------
City | ALIQUIPPA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15001-1726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-650-5414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.0032967
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------