Individual
AMY E POLIAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1506 S ONEIDA ST, APPLETON, WI 54915-1305
(920) 730-4959
Mailing address
1506 S ONEIDA ST, APPLETON, WI 54915-1305
(920) 730-4959
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
175436
WI
363LF0000X
Family Nurse Practitioner
Primary
4443
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100014952
—
WI
Enumeration date
12/07/2010
Last updated
01/03/2023
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