| Doctor Name: | MRS. CHARLOTTE MILES PORTER |
| NPI Number: | 1548598964 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 9210 Hanover Cv Converse, TX - 781092947 |
| Business Phone Number: | 2102512922 |
| Business Fax Number: | |
| Mailing Address: | 9210 Hanover Cv, CONVERSE |
| State: | TX |
| Postal Code: | 781092947 |
| Phone Number: | 2102512922 |
| Fax Number: | |
| NPI Enumeration Date: | 11/23/2009 |
| NPI Last Update Date: | 11/23/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246RM2200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Technician, Pathology |
| Taxonomy Specialization: | Medical Laboratory |
| Taxonomy Definition: | |