Individual
POLLY JEAN PAHLOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
W10752 BLUEBERRY POINT RD, PEMBINE, WI 54119-9251
(561) 244-5846
Mailing address
W10752 BLUEBERRY POINT RD, PEMBINE, WI 54119-9251
(561) 244-5846
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35017700
MEDICAID PROVIDER NUMBER
WI
Enumeration date
10/09/2007
Last updated
10/09/2007
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