Provider Demographics
NPI:1265674527
Name:PRIMUS, POLLY M (BA)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:M
Last Name:PRIMUS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 S EISENHOWER AVE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-1562
Mailing Address - Country:US
Mailing Address - Phone:641-424-2075
Mailing Address - Fax:641-424-9555
Practice Address - Street 1:123 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50441-2102
Practice Address - Country:US
Practice Address - Phone:641-456-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker