Provider Demographics
NPI:1972225365
Name:POOR, ELISSA HERMAN (A-GNP-C)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:HERMAN
Last Name:POOR
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PINE TREE LN
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-9587
Mailing Address - Country:US
Mailing Address - Phone:919-259-3313
Mailing Address - Fax:
Practice Address - Street 1:150 PARKWAY OFFICE CT STE 200
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-0002
Practice Address - Country:US
Practice Address - Phone:984-974-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPOOR-QN9XF363LA2200X
NC5016926363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health