Individual
REBECCA MARIE POLKABLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
15021 W BELL RD STE 125, SURPRISE, AZ 85374-3916
(623) 476-7880
(623) 476-7890
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 579-3203
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4661
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
642812
—
AZ
01
—
Z302379
MEDICARE
AZ
Enumeration date
07/23/2010
Last updated
12/05/2023
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