Individual
MARY JO POREMBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
520 VALLEY VIEW DR, MOLINE, IL 61265-6152
(309) 762-3621
(309) 762-3690
Mailing address
520 VALLEY VIEW DR, MOLINE, IL 61265-6194
(309) 762-3621
(309) 762-3690
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001636
IA
363A00000X
Physician Assistant
Primary
085001152
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
193318
IA HEALTH SOLUTIONS
—
01
—
234526
MIDLANDS CHOICE
—
01
—
8121085
BCBS
IL
01
—
970021096
RR MEDICARE
—
01
—
97854
WELLMARK
—
01
—
IL0168
JOHN DEERE FAMILY
—
Enumeration date
01/04/2006
Last updated
01/06/2011
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