Provider Demographics
NPI:1053434183
Name:POLANCO, WANDA I (RN)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:I
Last Name:POLANCO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4056
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-4056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ANEXO HOSPITAL BUEN SASMARITANO
Practice Address - Street 2:CENTRO DE METADONA DE AGUADILLA
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605-4056
Practice Address - Country:US
Practice Address - Phone:787-891-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26761163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)