Individual
PAVI ELLE SHANELL POOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16874 AVON AVE, DETROIT, MI 48219-4143
(734) 837-2229
Mailing address
16874 AVON AVE, DETROIT, MI 48219-4143
(734) 837-2229
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703113526
MI
Other
Enumeration date
08/11/2014
Last updated
08/11/2014
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