Provider Demographics
NPI:1598160947
Name:POLIHROM, KATHERINE MARY
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY
Last Name:POLIHROM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PARNASSUS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2203
Mailing Address - Country:US
Mailing Address - Phone:159-816-0947
Mailing Address - Fax:415-476-9516
Practice Address - Street 1:500 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2203
Practice Address - Country:US
Practice Address - Phone:159-816-0947
Practice Address - Fax:415-476-9516
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5946363LF0000X
MARN2294749367500000X
CANA95002359367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily