Provider Demographics
NPI:1902974538
Name:POLAND, LYLIA JEAN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LYLIA
Middle Name:JEAN
Last Name:POLAND
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 1:515 W WALL ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IA
Mailing Address - Zip Code:52590-1333
Mailing Address - Country:US
Mailing Address - Phone:641-898-2898
Mailing Address - Fax:641-898-2820
Practice Address - Street 1:515 W WALL ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IA
Practice Address - Zip Code:52590-1333
Practice Address - Country:US
Practice Address - Phone:641-898-2898
Practice Address - Fax:641-898-2820
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113922363LW0102X
IAF157207363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428302103Medicaid