Shirley Jean Poole, RD CSP LDN

Primary specialty

Pediatric Nutrition Registered DietitianTaxonomy code 133VN1004X

Practice address

1401 E State St
Rockford, IL 61104-2315

Phone

(815) 489-4667

Fax

(815) 964-5404

NPI assigned

Mar 15, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205960705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11249 CHANEY DR",
            "city": "MACHESNEY PARK",
            "state": "IL",
            "postal_code": "611157438",
            "telephone_number": "815-489-4667",
            "fax_number": "815-967-5404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611042315",
            "telephone_number": "815-489-4667",
            "fax_number": "815-964-5404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "SHIRLEY",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "RD CSP LDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jill Marie Polsean, PTA
• Kelly Polz
• Aramide A Ponnle, DPT
• Kasey L Pontarelli, P.A.-C.
• James Cicero Poole, M.D.
• Brandon Matthew Popp, DO
• Lori Poppen, LCPC
• Portable Medical Resources LTD
• Eliott Porter, PTA
• Kirstin Journey Porter, RBT

• Pediatric Nutrition Registered Dietitian in Rockford, IL
• Providers in Rockford, IL by specialty
• Pediatric Nutrition Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.