Provider Demographics
NPI:1023011210
Name:POLAKOWSKI, MAUREEN STANEK (CRNP, DNP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:STANEK
Last Name:POLAKOWSKI
Suffix:
Gender:F
Credentials:CRNP, DNP
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:ANN
Other - Last Name:STANEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1517 HEARTHSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-7408
Mailing Address - Country:US
Mailing Address - Phone:570-854-5102
Mailing Address - Fax:
Practice Address - Street 1:4835 LBJ FWY STE 900
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-6001
Practice Address - Country:US
Practice Address - Phone:844-941-3087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP004369B363L00000X, 363LF0000X
TX1116044363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA008562F6KMedicare PIN
PA025687Medicare ID - Type Unspecified