Basic Information
| Provider Information | |||||||||
| NPI: | 1639129299 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLSON | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | MSN/FNP, CRNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14506 W GRANITE VALLEY DR | ||||||||
| Address2: | #205 | ||||||||
| City: | SUN CITY WEST | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853756010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235845626 | ||||||||
| FaxNumber: | 6235848998 | ||||||||
| Practice Location | |||||||||
| Address1: | 14506 W GRANITE VALLEY DR | ||||||||
| Address2: | #205 | ||||||||
| City: | SUN CITY WEST | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853756010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235845626 | ||||||||
| FaxNumber: | 6235848998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 01/18/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F0604150 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 5124334 | 01 | AZ | AETNA | OTHER | 730511 | 01 | AZ | UNITED HEALTHCARE | OTHER | P0185990 | 01 | AZ | BCBS OUT OF AREA | OTHER | 1912990094 | 01 | AZ | AHCCCS | OTHER | 2Z3248 | 01 | AZ | HEALTHNET | OTHER |