Provider Demographics
NPI:1841204674
Name:POOLE, DONNA LYNN (RN)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LYNN
Last Name:POOLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1030
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3967
Mailing Address - Country:US
Mailing Address - Phone:843-761-8282
Mailing Address - Fax:843-761-7308
Practice Address - Street 1:403 STONEY LANDING ROAD
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3967
Practice Address - Country:US
Practice Address - Phone:643-761-8282
Practice Address - Fax:643-761-7308
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10512982084P0800X
SCRN214170101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry