Individual
MR. MARK J POULIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4909 E MCDOWELL RD, PHOENIX, AZ 85008-7735
(602) 685-6000
(602) 275-1355
Mailing address
3003 N CENTRAL AVE, SUITE 200, PHOENIX, AZ 85012-2902
(602) 685-6000
(602) 302-7925
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP1737
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
RN108520
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
816233
—
AZ
Enumeration date
06/29/2006
Last updated
12/06/2016
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