Provider Demographics
NPI:1427250117
Name:POOLE, REGINA D (NP)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:D
Last Name:POOLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LAWRENCE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3301
Mailing Address - Country:US
Mailing Address - Phone:610-492-5900
Mailing Address - Fax:610-492-5903
Practice Address - Street 1:30 LAWRENCE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3301
Practice Address - Country:US
Practice Address - Phone:610-492-5900
Practice Address - Fax:610-492-5903
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA005969363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner