Provider Demographics
NPI:1508921370
Name:POORMON, NANCY L (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:L
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 1:1083 WATERLOO GENEVA RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-1202
Mailing Address - Country:US
Mailing Address - Phone:315-539-4049
Mailing Address - Fax:315-539-4394
Practice Address - Street 1:928 WATERLOO GENEVA RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-1262
Practice Address - Country:US
Practice Address - Phone:315-539-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237817-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse