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NPI Code Detail

MEDICARE: MS. JENNIFER OLSEN POLNIAK R.D., C.D.E, PA-C

MEDICARE: MS. JENNIFER OLSEN POLNIAK R.D., C.D.E, PA-C
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
1133V00000XRegistered Dietitian0221025253MO
2363A00000XPhysician Assistant
3363A00000XPhysician Assistant2016024375MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
109720278OTHERDIABETES EDUCATOR CERTIFI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
32001025253OTHERMOSTATE LICENSE DIETITIAN

General Provider Information

NPI Number : 1710192588
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER OLSEN POLNIAK R.D., C.D.E, PA-C
Provider Business Mailing Address
First Line : PO BOX 843966
Second Line :
City : KANSAS CITY
State : MO
Zip : 64184-3966
Country : US
Telephone Number : 573-884-3300
Fax Number : 573-884-0943
Provider Business Practice Location Address
First Line : 303 N KEENE ST STE 301
Second Line :
City : COLUMBIA
State : MO
Zip : 65201-8053
Country : US
Telephone Number : 573-882-8000
Fax Number : 573-882-6600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2007
Last Update Date : 03/01/2023

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