Provider Demographics
NPI:1972332856
Name:POLES, ANASTASIA KIMBERLY (LPN)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:KIMBERLY
Last Name:POLES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 CLIFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-5638
Mailing Address - Country:US
Mailing Address - Phone:585-635-3389
Mailing Address - Fax:
Practice Address - Street 1:1341 CLIFFORD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-5638
Practice Address - Country:US
Practice Address - Phone:585-635-3389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349374164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse