Provider Demographics
NPI:1265184642
Name:POLHAMUS, EMILY GRACE (APRN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:GRACE
Last Name:POLHAMUS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0640
Mailing Address - Country:US
Mailing Address - Phone:252-536-5844
Mailing Address - Fax:252-519-0154
Practice Address - Street 1:919 JR HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SCOTLAND NECK
Practice Address - State:NC
Practice Address - Zip Code:27874-1219
Practice Address - Country:US
Practice Address - Phone:252-826-3143
Practice Address - Fax:252-826-3110
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5021138363LF0000X
FLAPRN11016854363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily