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General NPI Number Information
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NPI Number | 1821933706
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Entity Type | Individual
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Provider Name | MARJORIE L POLHAMUS RN
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Gender | Female
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Dates
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Enumeration Date | 04/20/2026
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 637 SOUTH CENTER STREET
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City | SPRINGFIELD
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State | OH
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Zip | 45506
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Country | US
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Telephone | 937-313-1117
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Fax |
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Provider Business Mailing Address
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Address Line | 203 S STATE ROUTE 48
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City | LUDLOW FALLS
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State | OH
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Zip | 45339-9796
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Country | US
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Telephone | 937-313-1117
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Fax | 877-518-2797
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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 | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 267181
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License Number State | OH
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