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Individual
STEPHANIE PORTER
Active
Individual
STEPHANIE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
224900000X
Mastectomy Fitter
BAP-TA-10201665
OR
247200000X
Other Technician
Primary
BAP-FA-10213306
OR
405300000X
Prevention Professional
BAP-TA-10201665
OR
Other
Enumeration date
08/20/2024
Last updated
08/20/2024
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