| 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: | |