Provider Demographics
NPI:1093451759
Name:POOLE, HANNAH NICOLE
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:NICOLE
Last Name:POOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3398 UNIVERSITY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-7262
Mailing Address - Country:US
Mailing Address - Phone:304-288-3579
Mailing Address - Fax:
Practice Address - Street 1:3398 UNIVERSITY AVE APT 2
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-7262
Practice Address - Country:US
Practice Address - Phone:304-288-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program