Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 0024170055 | VA |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 0001222851 | VA |
NPI | 1093071961 |
---|---|
Provider Name | Joann Marie Poole |
First Address | Scott Afb, IL 62225-5250 |
Second Address | Bellevue, NE 68123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2012 |
Last Update Date | 16/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093071961 | NPI (01) | |
1093071961 | NPI (01) | MN |