Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | R128490 | MD |
NPI | 1962573477 |
---|---|
Provider Name | Carolyn J. Porter |
First Address | Kalispell, MT 59901-5607 |
Second Address | Kalispell, MT 59901-5607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 10/02/2012 |