Provider Demographics
NPI:1962611236
Name:POORE, ANNE O'NEAL (FNP)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:O'NEAL
Last Name:POORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:80 BAYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2509
Mailing Address - Country:US
Mailing Address - Phone:415-457-2586
Mailing Address - Fax:415-482-9365
Practice Address - Street 1:16 RITTER ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3323
Practice Address - Country:US
Practice Address - Phone:415-457-8182
Practice Address - Fax:415-457-3490
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN 418826 NP 8392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily