Provider Demographics
NPI:1669600474
Name:POOK, NICOLE S (LPN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:S
Last Name:POOK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 W PORTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-2323
Mailing Address - Country:US
Mailing Address - Phone:262-483-8936
Mailing Address - Fax:
Practice Address - Street 1:1211 W PORTVIEW DR
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-2323
Practice Address - Country:US
Practice Address - Phone:262-483-8936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI309579-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse