Provider Demographics
NPI:1548051600
Name:POLOWCZUK, LINDSAY (NP)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:POLOWCZUK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:THOMASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:309 N WESTON ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-1625
Mailing Address - Country:US
Mailing Address - Phone:864-787-2451
Mailing Address - Fax:
Practice Address - Street 1:17 CALEDON CT STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3170
Practice Address - Country:US
Practice Address - Phone:864-232-7734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4469363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health