Provider Demographics
NPI:1477844157
Name:POORMON, TONI M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:M
Last Name:POORMON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 CAUWELS RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NY
Mailing Address - Zip Code:14505-9535
Mailing Address - Country:US
Mailing Address - Phone:585-520-5088
Mailing Address - Fax:
Practice Address - Street 1:4201 CAUWELS RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NY
Practice Address - Zip Code:14505-9535
Practice Address - Country:US
Practice Address - Phone:585-520-5088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207971164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse