MEDICARE: MAUREEN STANEK POLAKOWSKI CRNP, DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	VP004369B	PA
2	363LF0000X	Family Nurse Practitioner	VP004369B	PA
3	363L00000X	Nurse Practitioner	1116044	TX

General Provider Information

NPI Number	:	1023011210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN STANEK POLAKOWSKI CRNP, DNP

Provider Business Mailing Address
First Line	:	1517 HEARTHSTONE DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75023-7408
Country	:	US
Telephone Number	:	570-854-5102
Fax Number	:

Provider Business Practice Location Address
First Line	:	4835 LBJ FWY STE 900
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-6001
Country	:	US
Telephone Number	:	844-941-3087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	02/27/2024

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