Basic Information
Provider Information
NPI: 1780051409
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: POOLE
FirstName: MARGARET
MiddleName: ELAINE
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 856 J CLYDE MORRIS BLVD
Address2: SUITE A
City: NEWPORT NEWS
State: VA
PostalCode: 236011318
CountryCode: US
TelephoneNumber: 7575944006
FaxNumber:  
Practice Location
Address1: 1000 OLD DENBIGH BLVD
Address2: SUTIE 1020A
City: NEWPORT NEWS
State: VA
PostalCode: 236022017
CountryCode: US
TelephoneNumber: 7578752009
FaxNumber: 7573691042
Other Information
ProviderEnumerationDate: 08/28/2015
LastUpdateDate: 08/28/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LG0600X0024172693VAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology

No ID Information.


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