Provider Demographics
NPI:1972118339
Name:POOLE, ANITRA L (HOMEHEALTH AIDE)
Entity type:Individual
Prefix:
First Name:ANITRA
Middle Name:L
Last Name:POOLE
Suffix:
Gender:F
Credentials:HOMEHEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3495 E 98TH ST APT 915
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-5543
Mailing Address - Country:US
Mailing Address - Phone:216-358-8228
Mailing Address - Fax:
Practice Address - Street 1:3495 E 98TH ST APT 915
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-5543
Practice Address - Country:US
Practice Address - Phone:216-358-8228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide