Provider Demographics
NPI:1396395521
Name:POU, MARCELINE MARYANN
Entity Type:Individual
Prefix:MRS
First Name:MARCELINE
Middle Name:MARYANN
Last Name:POU
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 1:3580 GORGE PL
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-7083
Mailing Address - Country:US
Mailing Address - Phone:704-674-8354
Mailing Address - Fax:
Practice Address - Street 1:3580 GORGE PL
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-7083
Practice Address - Country:US
Practice Address - Phone:704-674-8354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider