Provider Demographics
NPI:1356771612
Name:POLANCO, HEATHER (STNA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:POLANCO
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 THORPE DR
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-1622
Mailing Address - Country:US
Mailing Address - Phone:419-357-9883
Mailing Address - Fax:
Practice Address - Street 1:411 THORPE DR
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-1622
Practice Address - Country:US
Practice Address - Phone:419-357-9883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400741080408376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide