Provider Demographics
NPI:1356307599
Name:POLAK, ERIN ERKMANN (RN, MSN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:ERKMANN
Last Name:POLAK
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:A
Other - Last Name:ERKMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,MSN,BC,FNP
Mailing Address - Street 1:4809 W 157TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66224-3811
Mailing Address - Country:US
Mailing Address - Phone:913-897-0644
Mailing Address - Fax:
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-3575
Practice Address - Fax:816-983-6885
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1999134588363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200255960AMedicaid
MO429065105Medicaid
Q13718Medicare UPIN
269C987Medicare ID - Type Unspecified