Individual
PRISCILLA POORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
303 NW 11TH ST, FAIRFIELD, IL 62837-1203
(618) 842-4617
Mailing address
303 NW 11TH ST, FAIRFIELD, IL 62837-1203
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209026764
IL
Other
Enumeration date
02/01/2023
Last updated
02/01/2023
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