Individual
JAMIE POLIVKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
140 LOWER BORONDO, LA MARQUE, TX 77568-3079
(832) 863-1668
Mailing address
140 LOWER BORONDO, LA MARQUE, TX 77568-3079
(832) 863-1668
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
751211
TX
Other
Enumeration date
10/01/2018
Last updated
10/01/2018
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