Provider Demographics
NPI:1356056667
Name:POOLE, THERESA RUNE'
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:RUNE'
Last Name:POOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9161 PEACHBLOSSOM CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-4811
Mailing Address - Country:US
Mailing Address - Phone:513-999-4204
Mailing Address - Fax:
Practice Address - Street 1:9161 PEACHBLOSSOM CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-4811
Practice Address - Country:US
Practice Address - Phone:513-999-4204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide