MEDICARE: DEBRA DIANNE POGUE MSN

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	163W00000X	Registered Nurse	207892	OH
2	363LA2200X	Adult Health Nurse Practitioner	10721	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336442011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA DIANNE POGUE MSN

Provider Business Mailing Address
First Line	:	10475 MONTGOMERY RD
Second Line	:	SUITE 1J
City	:	CINCINNATI
State	:	OH
Zip	:	45242-5201
Country	:	US
Telephone Number	:	513-791-5548
Fax Number	:	513-791-5549

Provider Business Practice Location Address
First Line	:	10475 MONTGOMERY RD
Second Line	:	SUITE 1J
City	:	CINCINNATI
State	:	OH
Zip	:	45242-5201
Country	:	US
Telephone Number	:	513-791-5548
Fax Number	:	513-791-5549

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

Provider Enumeration Date	:	12/17/2010
Last Update Date	:	04/08/2011

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