Provider Demographics
NPI:1114449451
Name:POLASHUK, NANCY I (PA-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:I
Last Name:POLASHUK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 ROSEPOINTE WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17362-8947
Mailing Address - Country:US
Mailing Address - Phone:717-683-5579
Mailing Address - Fax:
Practice Address - Street 1:220 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:PA
Practice Address - Zip Code:17362-1114
Practice Address - Country:US
Practice Address - Phone:717-703-0990
Practice Address - Fax:877-409-3567
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA004189363A00000X
PAMA059135363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant