Individual
POLLY JO LEISURE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
24276 AIRPORT RD, EAGLE BUTTE, SD 57625-8021
(605) 964-7724
Mailing address
5061 NICHOLAS DR, BIRMINGHAM, AL 35215-4064
(205) 352-7581
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1-155980
AL
Other
Enumeration date
01/17/2020
Last updated
01/17/2020
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