Individual
CARLENE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN.
Contact information
Practice address
4405 WEAVER PKWY, WARRENVILLE, IL 60555-3269
(630) 352-5300
(630) 352-5499
Mailing address
4405 WEAVER PKWY, WARRENVILLE, IL 60555-3269
(630) 352-5300
(630) 352-5499
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-001548
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
206147104
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
CA4748
RAILROAD MEDICARE PTAN (GROUP)
IL
01
—
P01090259
RAILROAD MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
03/31/2006
Last updated
11/29/2012
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