| Doctor Name: | MRS. GWEN LEE PORTER |
| NPI Number: | 1699986661 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 20872 |
| Business Practice Address: | 24 W 39th St Shadyside, OH - 439471106 |
| Business Phone Number: | 7406761710 |
| Business Fax Number: | 7406767200 |
| Mailing Address: | 24 W 39th St, SHADYSIDE |
| State: | OH |
| Postal Code: | 439471106 |
| Phone Number: | 7406761710 |
| Fax Number: | 7406767200 |
| NPI Enumeration Date: | 05/24/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC0400X |
| License Number: | 20872 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Case Management |
| Taxonomy Definition: | |