Provider Demographics
NPI:1659610533
Name:POLING, MIKAELA I (BA)
Entity Type:Individual
Prefix:MS
First Name:MIKAELA
Middle Name:I
Last Name:POLING
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 154
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-9519
Mailing Address - Country:US
Mailing Address - Phone:304-460-9038
Mailing Address - Fax:
Practice Address - Street 1:46 N TENNEY DR
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-8538
Practice Address - Country:US
Practice Address - Phone:304-472-0318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program