Doctor Name: | MRS. MICHELE LYNN POULOS |
NPI Number: | 1053484287 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN, MSN, ANP-C |
License Number: | 01143NP |
Business Practice Address: | 2500 W Strub Rd Suite 230 Sandusky, OH - 448705390 |
Business Phone Number: | 4196266891 |
Business Fax Number: | 4196268009 |
Mailing Address: | Po Box 378, SANDUSKY |
State: | OH |
Postal Code: | 448710378 |
Phone Number: | 4196091112 |
Fax Number: | 4196091123 |
NPI Enumeration Date: | 11/16/2006 |
NPI Last Update Date: | 09/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 01143NP |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |