Active NPI
Elizabeth M Polensky
- Student in an Organized Health Care Education/Training Program
- Colville, WA
National Provider Identifier
1720587678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- CG60829222
- Practice address
- 165 E Hawthorne Ave
Colville, WA 99114-2629 - Phone
- (509) 684-4597
- NPI assigned
- Feb 6, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | CG60829222 | WA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | CG60829222 | WA | Primary |
Addresses
Primary practice location
165 E Hawthorne Ave
Colville, WA 99114-2629
Mailing address
165 E Hawthorne Ave
Colville, WA 99114-2629
Phone (509) 684-4597
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG60829222 | WA | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544745600000",
"number": "1720587678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "165 E HAWTHORNE AVE",
"city": "COLVILLE",
"state": "WA",
"postal_code": "991142629",
"telephone_number": "509-684-4597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "165 E HAWTHORNE AVE",
"city": "COLVILLE",
"state": "WA",
"postal_code": "991142629",
"telephone_number": "509-684-4597"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLENSKY",
"first_name": "ELIZABETH",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-06",
"last_updated": "2018-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "WA",
"license": "CG60829222",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "WA",
"license": "CG60829222",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colville, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.