Provider Demographics
NPI:1235314048
Name:POOL, REGINA MAE (RN)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:MAE
Last Name:POOL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 MAYFIELD CT
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1331
Mailing Address - Country:US
Mailing Address - Phone:440-988-4267
Mailing Address - Fax:
Practice Address - Street 1:212 SLEEPY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-2791
Practice Address - Country:US
Practice Address - Phone:440-988-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH270470163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2065170Medicaid