Provider Demographics
NPI:1124439971
Name:POOR, JERI (CRNA)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:
Last Name:POOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JERI
Other - Middle Name:
Other - Last Name:POLCHLOPEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 535750
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-5510
Mailing Address - Country:US
Mailing Address - Phone:866-507-5244
Mailing Address - Fax:954-858-1815
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-299-5451
Practice Address - Fax:855-851-4405
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY616605-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered