Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | SP006420C | PA |
NPI | 1003871138 |
---|---|
Provider Name | Ms. Patricia A. Porter |
First Address | Danville, PA 17822-3034 |
Second Address | Danville, PA 17822-1341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P10144 | (02) |