Provider Demographics
NPI:1306093828
Name:STRUNK, POLLYANNA HENZMAN (ARNP)
Entity type:Individual
Prefix:
First Name:POLLYANNA
Middle Name:HENZMAN
Last Name:STRUNK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-1820
Mailing Address - Country:US
Mailing Address - Phone:502-893-5502
Mailing Address - Fax:502-721-8670
Practice Address - Street 1:6500 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-1820
Practice Address - Country:US
Practice Address - Phone:502-893-5502
Practice Address - Fax:502-721-8670
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5742P363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3763617000OtherPASSPORT ADVANTAGE
KY7100065440Medicaid
KYP00810967OtherRR MEDICARE
KY000000649895OtherBC BS OF KY
KY50027266OtherPASSPORT
KY50027266OtherPASSPORT