| Doctor Name: | THERESA A. PORCARELLI |
| NPI Number: | 1538440821 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RDMS, RVT, RDCS |
| License Number: | 3082 |
| Business Practice Address: | 1076 W Hayden Ave Hayden, ID - 838358793 |
| Business Phone Number: | 2087722823 |
| Business Fax Number: | |
| Mailing Address: | 807 W Lakeshore Dr, COEUR D ALENE |
| State: | ID |
| Postal Code: | 838142131 |
| Phone Number: | 2086612366 |
| Fax Number: | |
| NPI Enumeration Date: | 08/31/2011 |
| NPI Last Update Date: | 08/31/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471S1302X |
| License Number: | 3082 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Sonography |
| Taxonomy Definition: | |