Healthcare Provider Details

I. General information

NPI: 1932330099
Provider Name (Legal Business Name): MRS. SABRINA ANNETTA POOLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SO. INDEPENDENCE MALL WEST
PHILADELPHIA PA
19106
US

IV. Provider business mailing address

520 LAVEROCK RD
GLENSIDE PA
19038-2816
US

V. Phone/Fax

Practice location:
  • Phone: 215-399-0980
  • Fax: 215-399-0987
Mailing address:
  • Phone: 215-884-4496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: