Provider Demographics
NPI:1811423023
Name:POELLNITZ, LOUIS JR
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:POELLNITZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 DAHLIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611
Mailing Address - Country:US
Mailing Address - Phone:419-265-0427
Mailing Address - Fax:
Practice Address - Street 1:4224 DAHLIA DRIVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611
Practice Address - Country:US
Practice Address - Phone:419-265-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide