Healthcare Provider Details

I. General information

NPI: 1922058148
Provider Name (Legal Business Name): JILL A POOLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988102 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8102
US

IV. Provider business mailing address

988102 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8102
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-4015
  • Fax: 402-559-8715
Mailing address:
  • Phone: 402-559-4015
  • Fax: 402-559-8715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number23068
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: