Healthcare Provider Details

I. General information

NPI: 1750459962
Provider Name (Legal Business Name): MARY JANE POOL RN, MS, CIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LRMC, CMR 402 BOX 1030
NEW YORK APO, AE
09180
DE

IV. Provider business mailing address

LRMC, CMR 402 BOX 1030
NEW YORK APO, AE
09180
DE

V. Phone/Fax

Practice location:
  • Phone: 06371868508
  • Fax: 06371867350
Mailing address:
  • Phone: 06371868508
  • Fax: 06371867350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License NumberRN1005852
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: