Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1053926964 |
---|---|
Provider Name | Deann Porter |
First Address | Bridgeton, MO 63044-5007 |
Second Address | St Louis, MO 63114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2020 |
Last Update Date | 09/09/2020 |