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Individual

MRS. MARIA GWENDOLINE POLK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN MSN GNP-BC

Contact information

Practice address
4660 BEECHNUT ST STE 218-A, HOUSTON, TX 77096-1824
(713) 521-0006
Mailing address
4660 BEECHNUT ST STE 218, HOUSTON, TX 77096-1825
(713) 521-0006

Taxonomy

Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
425936
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
190358502
TX
01
8Y3481
BC/BS
TX
01
P00731415
MEDICARE RAILROAD
TX
01
P00784266
MEDICARE RAILROAD
TX
Enumeration date
04/09/2007
Last updated
07/11/2012
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