Provider Demographics
NPI:1881729861
Name:POOLE-GILSON, EVA J
Entity type:Individual
Prefix:MS
First Name:EVA
Middle Name:J
Last Name:POOLE-GILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 KEOUGH HOT SPRINGS RD SPC 11
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-7236
Mailing Address - Country:US
Mailing Address - Phone:760-872-2446
Mailing Address - Fax:
Practice Address - Street 1:452 OLD MAMMOTH ROAD, SUITE 304
Practice Address - Street 2:
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546
Practice Address - Country:US
Practice Address - Phone:760-924-1740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator