MEDICARE: ELLEN M CHAPMAN POGUE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209004233	IL
2	207Q00000X	Family Medicine Physician	209004233	IL

General Provider Information

NPI Number	:	1114996642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN M CHAPMAN POGUE NP

Provider Business Mailing Address
First Line	:	354 US ROUTE 51
Second Line	:
City	:	DU QUOIN
State	:	IL
Zip	:	62832-4211
Country	:	US
Telephone Number	:	618-542-6272
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 N WASHINGTON ST
Second Line	:	SUITE 2
City	:	DU QUOIN
State	:	IL
Zip	:	62832-1403
Country	:	US
Telephone Number	:	618-542-2129
Fax Number	:	618-542-2903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	11/02/2009

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