Provider Demographics
NPI:1891521712
Name:POLSTON, RACE (LPN)
Entity type:Individual
Prefix:
First Name:RACE
Middle Name:
Last Name:POLSTON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 E SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5741
Mailing Address - Country:US
Mailing Address - Phone:509-844-1507
Mailing Address - Fax:
Practice Address - Street 1:1302 W GARDNER AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2059
Practice Address - Country:US
Practice Address - Phone:509-503-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60651685164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse