MRS. SHIRLEY JEAN POOLE (NPI# 1205960705) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205960705 |
| Entity Type | Individual |
| Full Name | MRS. SHIRLEY JEAN POOLE |
| Credential | RD CSP LDN |
| Practice Address |
1401 E State St Rockford IL 61104-2315 |
| Mailing Address |
11249 Chaney Dr Machesney Park IL 61115-7438 |
| Practice Telephone | 8154894667 |
| Practice Fax Number | 8159645404 |
| Mailing Telephone | 8154894667 |
| Mailing Fax Number | 8159675404 |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133VN1004X |
Dietitian, Registered Specialization: Nutrition, Pediatric |
IL | Dietary & Nutritional Service Providers |
| Street Address |
1401 E STATE ST |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61104-2315 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003899196 | Thomas Danko | Pediatrics | 1401 E State St, Rockford, IL 61104-2315 | 2005-11-22 |
| 1184232621 | Sound Physicians Emergency Medicine of Illinois LLC | Emergency Medicine | 1401 E State St, Rockford, IL 61104-2315 | 2020-07-21 |
| 1235764556 | Alexandra Paganis | Nurse Practitioner | 1401 E State St, Rockford, IL 61104-2315 | 2020-03-06 |
| 1538790266 | Sherri L Paprocki | Emergency Medicine | 1401 E State St, Rockford, IL 61104-2315 | 2020-01-31 |
| 1417593310 | Jason C Hipe | Registered Nurse | 1401 E State St, Rockford, IL 61104-2315 | 2019-11-26 |
| 1487298642 | Matthew Montgomery | Physical Therapist | 1401 E State St, Rockford, IL 61104-2315 | 2019-10-31 |
| 1265076541 | Sarah Kemp | Occupational Therapist | 1401 E State St, Rockford, IL 61104-2315 | 2019-10-30 |
| 1891341939 | Swedishamerican Hospital | Pharmacy | 1401 E State St, Rockford, IL 61104-2315 | 2019-08-14 |
| 1306408885 | Jonathan Ray Nelson | Physical Therapy Assistant | 1401 E State St, Rockford, IL 61104-2315 | 2019-07-03 |
| 1124680608 | Kirsten Sympson | Occupational Therapy Assistant | 1401 E State St, Rockford, IL 61104-2315 | 2019-07-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699216564 | Swedishamerican Hospital | Nutritionist | 1415 E. State St., Lower Level A3, Rockford, IL 61104 | 2017-03-13 |
| 1376950485 | Swedishamerican Hospital | Nurse Practitioner | 1340 Charles St Ste 200, Rockford, IL 61104 | 2014-07-21 |
| 1871907774 | Oday Alsarraf | Psychiatry & Neurology | 1401 E State Street, Center for Mental Health, Swedish American Hospital, Rockford, IL 61104 | 2014-06-18 |
| 1962652339 | Children's Home and Aid | Community/Behavioral Health | 424 7th St, Rockford, IL 61104 | 2008-09-23 |
| 1689729535 | Swedishamerican Hospital | Nurse Practitioner | 1340 Charles St Ste 100, Rockford, IL 61104 | 2007-01-23 |
| 1790873016 | David J Schleicher | Obstetrics & Gynecology | 209 9th St Ste 200, Rockford, IL 61104 | 2006-10-11 |
| 1013026624 | Thomas Ryan Moss | Dentist | 1415 E State Street, Rockford, IL 61104 | 2006-08-29 |
| 1366452096 | Arturo Santiago Manas | Obstetrics & Gynecology | 1415 E State St Fl 8, Rockford, IL 61104 | 2006-08-08 |
| 1245263268 | William John Stout | Physician Assistant | 1401 E State Street, Rockford, IL 61104 | 2006-07-10 |
| 1689604969 | Prabha Chand Dosi | Pediatrics | 1401 E. State Street, Rockford, IL 61104 | 2006-07-03 |
| Find all providers in zip 61104 | ||||
| Taxonomy Code | 133VN1004X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| Specialization | Nutrition, Pediatric |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598238941 | Beth Helmold | Dietitian, Registered | 111 N 5th Ave, Morton, IL 61550-2103 | 2019-01-08 |
| 1831665405 | Grazyna Gawedzki | Dietitian, Registered | 829 Austin Ave, Park Ridge, IL 60068-2682 | 2018-10-22 |
| 1215446463 | Sarah Berglind | Dietitian, Registered | 7640 W Coach Rd, Palos Heights, IL 60463-1244 | 2017-09-20 |
| 1043757149 | Amanda Salley | Dietitian, Registered | 1900 Sycamore Rd, Homewood, IL 60430-2323 | 2017-01-26 |
| 1932641750 | Tara Todd | Dietitian, Registered | 3312 Forest Hill School Rd, Millstadt, IL 62260-3116 | 2016-11-10 |
| 1639553142 | Bianca Roe | Dietitian, Registered | 2630 W Bradley Pl Ste A, Chicago, IL 60618-4704 | 2015-07-14 |
| 1144620261 | Julie Ann Mota | Dietitian, Registered | 728 S Madison Ave, La Grange, IL 60525-2805 | 2014-08-26 |
| 1902205370 | Kathleen Sheldon | Dietitian, Registered | 5332 Woodland Ave, Western Springs, IL 60558-1854 | 2014-08-21 |
| 1487925996 | Amanda Nelson | Dietitian, Registered | 2814 Miller Rd, Geneva, IL 60134-3996 | 2012-01-16 |
| 1790090033 | Diane Martinez Dadivas | Dietitian, Registered | 8439 N Clifton Ave, Niles, IL 60714-1803 | 2010-08-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.