Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 64093 | CT |
NPI | 1003270638 |
---|---|
Provider Name | Nicole Poole |
First Address | Hartford, CT 06105-1207 |
Second Address | Hartford, CT 06105-1207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2016 |
Last Update Date | 05/10/2021 |