Doctor Name: | MS. SUSAN CAROLE PORTER |
NPI Number: | 1841546520 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MT |
License Number: | 805 |
Business Practice Address: | 550 Sixth Av N Wolf Point, MT - 592010729 |
Business Phone Number: | 4066535628 |
Business Fax Number: | 4066531177 |
Mailing Address: | 550 6th Ave North, WOLF POINT |
State: | MT |
Postal Code: | 59201 |
Phone Number: | 4066535628 |
Fax Number: | 4066531177 |
NPI Enumeration Date: | 07/31/2012 |
NPI Last Update Date: | 07/31/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 246QM0706X |
License Number: | 805 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Spec/Tech, Pathology |
Taxonomy Specialization: | Medical Technologist |
Taxonomy Definition: |