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General NPI Number Information
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NPI Number | 1962252338
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Entity Type | Individual
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Provider Name | JESSI ANN POLK
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Gender | Female
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Dates
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Enumeration Date | 03/26/2024
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 1542 16TH ST W STE 300
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City | WILLISTON
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State | ND
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Zip | 58801-3888
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Country | US
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Telephone | 701-572-2470
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 334
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City | ROZET
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State | WY
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Zip | 82727-0334
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Country | US
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Telephone | 701-290-2871
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 52887
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License Number State | WY
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