Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 640467 | NY |
N | 363LG0600X | Nurse Practitioner - Gerontology | 640467 | NY |
NPI | 1033634993 |
---|---|
Provider Name | Stephanie George Porter |
First Address | Huntington, NY 11743-2787 |
Second Address | Huntington, NY 11743-2787 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2017 |
Last Update Date | 17/03/2018 |