Provider Demographics
NPI:1972973212
Name:HASTIE, POLLY
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:
Last Name:HASTIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9089
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-9078
Mailing Address - Country:US
Mailing Address - Phone:513-706-1110
Mailing Address - Fax:
Practice Address - Street 1:56 EDWARDS VILLAGE BLVD
Practice Address - Street 2:SUITE 226
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-7802
Practice Address - Country:US
Practice Address - Phone:513-706-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COF1114057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily