MEDICARE: ANN POULIN PNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	454704	TX

General Provider Information

NPI Number	:	1245652825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN POULIN PNP

Provider Business Mailing Address
First Line	:	5819 HIGHWAY 6 STE 330
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4070
Country	:	US
Telephone Number	:	281-499-6300
Fax Number	:	281-499-7180

Provider Business Practice Location Address
First Line	:	5819 HIGHWAY 6 STE 330
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4070
Country	:	US
Telephone Number	:	281-499-6300
Fax Number	:	281-499-7180

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2014
Last Update Date	:	01/15/2014

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Directions to “ ANN POULIN PNP” Practice Location

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