Provider Demographics
NPI:1376365114
Name:POMINVILLE, MADELINE ELISE
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:ELISE
Last Name:POMINVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:CROGHAN
Mailing Address - State:NY
Mailing Address - Zip Code:13327-0304
Mailing Address - Country:US
Mailing Address - Phone:315-771-9124
Mailing Address - Fax:
Practice Address - Street 1:1342 NEW SENECA TPKE
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-8895
Practice Address - Country:US
Practice Address - Phone:315-685-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program