Provider Demographics
NPI:1578158457
Name:POOLE, LOIS JEAN
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:JEAN
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 1:793 ROBINSON RUN RD
Mailing Address - Street 2:
Mailing Address - City:RIVESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26588-8754
Mailing Address - Country:US
Mailing Address - Phone:304-680-3094
Mailing Address - Fax:
Practice Address - Street 1:793 ROBINSON RUN RD
Practice Address - Street 2:
Practice Address - City:RIVESVILLE
Practice Address - State:WV
Practice Address - Zip Code:26588-8754
Practice Address - Country:US
Practice Address - Phone:304-680-3094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV536528Medicaid