Provider Demographics
NPI:1750614095
Name:POOLE, PATRICIA ANN (CRNA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:POOLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 4860
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-2698
Mailing Address - Country:US
Mailing Address - Phone:843-651-2624
Mailing Address - Fax:843-491-4023
Practice Address - Street 1:5959 MONCLOVA RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1888
Practice Address - Country:US
Practice Address - Phone:419-597-5501
Practice Address - Fax:419-897-5502
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019933367500000X
WV50371367500000X
SC4073367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered