Provider Demographics
NPI:1891204970
Name:POLHILL, RONALD LAVERN JR (CPNP, RN)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:LAVERN
Last Name:POLHILL
Suffix:JR
Gender:M
Credentials:CPNP, RN
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Mailing Address - Street 1:1648 N HURON RD
Mailing Address - Street 2:
Mailing Address - City:PINCONNING
Mailing Address - State:MI
Mailing Address - Zip Code:48650-9509
Mailing Address - Country:US
Mailing Address - Phone:989-879-8080
Mailing Address - Fax:
Practice Address - Street 1:701 SOUTH LINCOLN ST.
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708
Practice Address - Country:US
Practice Address - Phone:989-895-9876
Practice Address - Fax:989-895-9780
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2018-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704222452163WP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics