Provider Demographics
NPI:1265721237
Name:POLACHEK, SANDRA ANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:POLACHEK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:ANN
Other - Last Name:LOPEZ KEMERLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4413 APPLETREE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3697
Mailing Address - Country:US
Mailing Address - Phone:816-390-3273
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1459
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55440-1459
Practice Address - Country:US
Practice Address - Phone:800-328-5979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005011210163W00000X
MO2011008776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse