Provider Demographics
NPI:1225338627
Name:POLSON, ANDREA NICOLE (RN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICOLE
Last Name:POLSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1475
Mailing Address - Street 2:BARKING WATER ROAD
Mailing Address - City:WEWOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74884-1475
Mailing Address - Country:US
Mailing Address - Phone:405-257-6282
Mailing Address - Fax:405-257-3344
Practice Address - Street 1:US HIGHWAY 56 & 270 JUNCTION
Practice Address - Street 2:BARKING WATER ROAD
Practice Address - City:WEWOKA
Practice Address - State:OK
Practice Address - Zip Code:74884-1475
Practice Address - Country:US
Practice Address - Phone:405-257-6282
Practice Address - Fax:405-257-3344
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0084059163WC1500X, 163WG0000X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WW0000XNursing Service ProvidersRegistered NurseWound Care