Provider Demographics
NPI:1255322491
Name:POLIUS-MCLEAN, MARIAN (CRNA)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:POLIUS-MCLEAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 NORTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1355
Mailing Address - Country:US
Mailing Address - Phone:609-871-9584
Mailing Address - Fax:
Practice Address - Street 1:120 MADISON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2055
Practice Address - Country:US
Practice Address - Phone:609-261-1660
Practice Address - Fax:609-261-1779
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN540977367500000X
NJMA107717367500000X
DEL6-0A00555367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered