Provider Demographics
NPI:1649915315
Name:POE, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:POE
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 1:290 HALE SMITH RD
Mailing Address - Street 2:
Mailing Address - City:FRENCH CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26218-2198
Mailing Address - Country:US
Mailing Address - Phone:681-404-7767
Mailing Address - Fax:304-471-2488
Practice Address - Street 1:8 N SPRING ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2720
Practice Address - Country:US
Practice Address - Phone:304-472-0395
Practice Address - Fax:304-472-4673
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker