Provider Demographics
NPI:1528456381
Name:PORTER, PATRICIA L (LPN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:PORTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2891 CHESTERVILLE SPARTA ROAD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43019
Mailing Address - Country:US
Mailing Address - Phone:740-358-9296
Mailing Address - Fax:
Practice Address - Street 1:2891 CHESTERVILLE SPARTA RD
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:OH
Practice Address - Zip Code:43019-2501
Practice Address - Country:US
Practice Address - Phone:740-358-9296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN158325164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse