MEDICARE: DR. JACQUELINE ROCHELLE POULOS N.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	11-1272	AZ

General Provider Information

NPI Number	:	1336418623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE ROCHELLE POULOS N.M.D

Provider Business Mailing Address
First Line	:	211 GROVE AVE
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86301-2911
Country	:	US
Telephone Number	:	928-774-1332
Fax Number	:	928-774-0042

Provider Business Practice Location Address
First Line	:	211 GROVE AVE
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86301-2911
Country	:	US
Telephone Number	:	928-774-1332
Fax Number	:	928-774-0042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	10/05/2025

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