Provider Demographics
NPI:1396192365
Name:POOLE, EMILY (RN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:POOLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:CHRISTENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1674 RIVERSIDE
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-8093
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17676 FORMOSA AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-7808
Practice Address - Country:US
Practice Address - Phone:651-356-5835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR221155-4163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health