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General NPI Number Information
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NPI Number | 1376685628
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Entity Type | Individual
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Provider Name | NICOLE LYNN POELLET NP
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 1251 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43222-1359
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Country | US
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Telephone | 614-274-1455
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Fax | 614-274-1433
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Provider Business Mailing Address
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Address Line | 1251 W BROAD ST 700 KMS PLACE
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City | COLUMBUS
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State | OH
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Zip | 43222-1359
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Country | US
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Telephone | 614-274-1455
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Fax | 614-274-1433
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704224225
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License Number State | MI
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