Provider Demographics
NPI:1679724637
Name:POOLE, ADA C (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ADA
Middle Name:C
Last Name:POOLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 SKYVEIW LANE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213
Mailing Address - Country:US
Mailing Address - Phone:513-351-5955
Mailing Address - Fax:
Practice Address - Street 1:3575 SKYVEIW LANE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213
Practice Address - Country:US
Practice Address - Phone:513-351-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 072172164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse