Provider Demographics
NPI:1558316208
Name:POOLE, ROSALIND LAJUNE (IDC)
Entity type:Individual
Prefix:MRS
First Name:ROSALIND
Middle Name:LAJUNE
Last Name:POOLE
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USSJOHN F KENNEDY CV67
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AA
Mailing Address - Zip Code:34095-2800
Mailing Address - Country:US
Mailing Address - Phone:904-270-5843
Mailing Address - Fax:
Practice Address - Street 1:USSJOHN F KENNEDY CV 67
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:34095-2800
Practice Address - Country:US
Practice Address - Phone:904-270-5843
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1710I1002X1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1710I1002XOtherINDEPENDENT DUTY CORPSMAN