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General NPI Number Information
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NPI Number | 1417774100
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Entity Type | Individual
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Provider Name | TYREKE POOLE RN, SNP
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Gender | Male
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Dates
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Enumeration Date | 09/24/2024
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 4494 PALMER RD N
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City | BETHESDA
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State | MD
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Zip | 20814
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Country | US
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Telephone | 301-295-4830
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Fax |
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Provider Business Mailing Address
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Address Line | 19420 RIDGECREST DR
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City | GERMANTOWN
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State | MD
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Zip | 20874-1539
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Country | US
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Telephone |
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Fax |
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 26NR18600700
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License Number State | NJ
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