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General NPI Number Information
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NPI Number | 1750790358
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Entity Type | Individual
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Provider Name | MARK POOLMAN
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Gender | Male
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 1 RALPH ENGELSTAD ARENA DR
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City | GRAND FORKS
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State | ND
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Zip | 58203-2205
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Country | US
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Telephone | 701-777-3107
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Fax | 701-777-6974
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Provider Business Mailing Address
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Address Line | 2324 PEBBLE BEACH RD
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City | EAST GRAND FORKS
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State | MN
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Zip | 56721-9002
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Country | US
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Telephone | 218-773-2142
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 143-95
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License Number State | ND
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