Provider Demographics
NPI:1427196021
Name:POE, BETH ANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:BETH ANNE
Middle Name:
Last Name:POE
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 1:22637 GRAVEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-6574
Mailing Address - Country:US
Mailing Address - Phone:302-856-1459
Mailing Address - Fax:302-856-6953
Practice Address - Street 1:22637 GRAVEL HILL RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-6574
Practice Address - Country:US
Practice Address - Phone:302-856-1459
Practice Address - Fax:302-856-6953
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0026707163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001129738Medicaid