Healthcare Provider Details

I. General information

NPI: 1720392533
Provider Name (Legal Business Name): KATHLEEN ELIZABETH POOL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 10/12/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W MARKET ST
TIFFIN OH
44883-2610
US

IV. Provider business mailing address

2200 JEFFERSON AVE 5TH FLOOR
TOLEDO OH
43604-7101
US

V. Phone/Fax

Practice location:
  • Phone: 419-447-6900
  • Fax: 419-448-7881
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN-284713
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN.CNM.11422
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: