Provider Demographics
NPI:1710057930
Name:POE, DEIRDRE CATHERINE (CNM)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:CATHERINE
Last Name:POE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7021
Mailing Address - Country:US
Mailing Address - Phone:336-832-6614
Mailing Address - Fax:
Practice Address - Street 1:801 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7021
Practice Address - Country:US
Practice Address - Phone:336-832-6614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7002059Medicaid
NC2592532AOtherMEDICARE PTAN
NC7002059Medicaid