Provider Demographics
NPI:1194855684
Name:POORE, MARY CAROLINA (NATUROPATHIC DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CAROLINA
Last Name:POORE
Suffix:
Gender:F
Credentials:NATUROPATHIC DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:809 N HUMPHREYS ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3027
Mailing Address - Country:US
Mailing Address - Phone:928-774-1770
Mailing Address - Fax:928-774-8170
Practice Address - Street 1:809 N HUMPHREYS ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3027
Practice Address - Country:US
Practice Address - Phone:928-774-1770
Practice Address - Fax:928-774-8170
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86-379175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath