MEDICARE: DONNA M POOLE RN

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	422689	TX

General Provider Information

NPI Number	:	1659659605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA M POOLE RN

Provider Business Mailing Address
First Line	:	8500 SHOAL CREEK BLVD
Second Line	:	BLDG.4 SUITE 150
City	:	AUSTIN
State	:	TX
Zip	:	78757-7591
Country	:	US
Telephone Number	:	512-835-0500
Fax Number	:	512-835-0502

Provider Business Practice Location Address
First Line	:	8500 SHOAL CREEK BLVD
Second Line	:	BLDG.4 SUITE 150
City	:	AUSTIN
State	:	TX
Zip	:	78757-7591
Country	:	US
Telephone Number	:	512-835-0500
Fax Number	:	512-835-0502

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

Provider Enumeration Date	:	07/25/2011
Last Update Date	:	07/25/2011

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