Individual
JACQUELINE POOLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7500 MERCY RD, OMAHA, NE 68124-2319
(402) 398-6940
Mailing address
7710 MERCY RD STE 401, OMAHA, NE 68124-2362
(402) 398-6248
(402) 829-8513
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2014021724
MO
207RP1001X
Pulmonary Disease Physician
Primary
30812
NE
281P00000X
Chronic Disease Hospital
2011020643
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
787000018
MEDICARE PTAN
MO
Enumeration date
07/15/2011
Last updated
12/12/2023
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