Doctor Name: | KIMBERLY PORTER |
NPI Number: | 1003297664 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CNM, WHNP-BC |
License Number: | 4704246721 |
Business Practice Address: | 118 E Benton St Greenville, MI - 488382333 |
Business Phone Number: | 6162582386 |
Business Fax Number: | 8666703144 |
Mailing Address: | 118 E Benton St, GREENVILLE |
State: | MI |
Postal Code: | 488382333 |
Phone Number: | 6162582386 |
Fax Number: | 8666703144 |
NPI Enumeration Date: | 06/09/2015 |
NPI Last Update Date: | 06/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LW0102X |
License Number: | 4704246721 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Women's Health |
Taxonomy Definition: |