Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 12177 | NC |
NPI | 1013131127 |
---|---|
Provider Name | Mrs. Lisa Gray Poole |
First Address | New Bern, NC 28562 |
Second Address | New Bern, NC 28562 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
383 | NC CNM (01) | NC |
ZM0000024 | NC PHARMACY BOARD (01) | NC |