MEDICARE: MS. ANGIE POOLE

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1740543172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGIE POOLE

Provider Business Mailing Address
First Line	:	3703 QUAKER LAKE ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-1410
Country	:	US
Telephone Number	:	702-409-3497
Fax Number	:

Provider Business Practice Location Address
First Line	:	3703 QUAKER LAKE ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-1410
Country	:	US
Telephone Number	:	702-409-3497
Fax Number	:

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

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	06/20/2012

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Directions to “ MS. ANGIE POOLE ” Practice Location

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