Provider Demographics
NPI:1114996642
Name:CHAPMAN POGUE, ELLEN M (NP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:CHAPMAN POGUE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:M
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:354 US ROUTE 51
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-4211
Mailing Address - Country:US
Mailing Address - Phone:618-542-6272
Mailing Address - Fax:
Practice Address - Street 1:20 N WASHINGTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-1403
Practice Address - Country:US
Practice Address - Phone:618-542-2129
Practice Address - Fax:618-542-2903
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004233363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P63955Medicare UPIN