Provider Demographics
NPI:1386744753
Name:POLENSKY, KAREN A (MS, RD/LDN, CDE)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:POLENSKY
Suffix:
Gender:F
Credentials:MS, RD/LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 PINE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-9668
Mailing Address - Country:US
Mailing Address - Phone:717-609-3537
Mailing Address - Fax:
Practice Address - Street 1:757 NORLAND AVE STE 204
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4231
Practice Address - Country:US
Practice Address - Phone:717-217-6820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003369133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPENDINGMedicare ID - Type Unspecified