MEDICARE: MARSHA SUE POHORELSKY APRN

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	207Q00000X	Family Medicine Physician	AP138588	TX

General Provider Information

NPI Number	:	1326529546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHA SUE POHORELSKY APRN

Provider Business Mailing Address
First Line	:	219 E RAILROAD ROW
Second Line	:
City	:	GIDDINGS
State	:	TX
Zip	:	78942-2639
Country	:	US
Telephone Number	:	979-542-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 E RAILROAD ROW
Second Line	:
City	:	GIDDINGS
State	:	TX
Zip	:	78942-2639
Country	:	US
Telephone Number	:	979-542-9000
Fax Number	:

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

Provider Enumeration Date	:	08/25/2018
Last Update Date	:	08/25/2018

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