Provider Demographics
NPI:1902457609
Name:SACCO EZZELL, POLLY (RN)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:
Last Name:SACCO EZZELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WATERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-7001
Mailing Address - Country:US
Mailing Address - Phone:610-876-9936
Mailing Address - Fax:
Practice Address - Street 1:1601 CHERRY ST STE 11484
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-1312
Practice Address - Country:US
Practice Address - Phone:215-255-7304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN328351L163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health