Provider Demographics
NPI:1629684857
Name:POULLAS, RACHEL ELIZABETH (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:POULLAS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:ELIZABETH
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:8314 WEATHERED WOOD TRL
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2876
Mailing Address - Country:US
Mailing Address - Phone:330-503-7256
Mailing Address - Fax:
Practice Address - Street 1:3893 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4706
Practice Address - Country:US
Practice Address - Phone:330-856-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022251500207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology