Individual
CLARISA MEDINA POELINIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
903 S 7TH ST STE C, ROCHELLE, IL 61068-9375
(815) 562-6976
(815) 562-9786
Mailing address
903 S 7TH ST STE C, ROCHELLE, IL 61068-9375
(815) 562-6976
(815) 562-9786
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.317970
IL
363LP0200X
Pediatric Nurse Practitioner
Primary
209.007592
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
376793031
MEDICARE PTAN
IL
01
—
376796015
MEDICARE PTAN
IL
Enumeration date
06/23/2009
Last updated
01/28/2013
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