Provider Demographics
NPI:1417760620
Name:POOLE, JASMINE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:POOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:VAUGHNSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45893-0032
Mailing Address - Country:US
Mailing Address - Phone:248-509-4344
Mailing Address - Fax:
Practice Address - Street 1:313 W FINDLAY ST APT A
Practice Address - Street 2:
Practice Address - City:VAUGHNSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45893-6509
Practice Address - Country:US
Practice Address - Phone:248-509-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide