Provider Demographics
NPI:1245652825
Name:POULIN, ANN (PNP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:POULIN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 HIGHWAY 6 STE 330
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4070
Mailing Address - Country:US
Mailing Address - Phone:281-499-6300
Mailing Address - Fax:281-499-7180
Practice Address - Street 1:5819 HIGHWAY 6 STE 330
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4070
Practice Address - Country:US
Practice Address - Phone:281-499-6300
Practice Address - Fax:281-499-7180
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX454704363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics