Individual
STEPHANIE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
833 SE MAIN STREET, #220, PORTLAND, OR 97214
(971) 359-3276
Mailing address
6841 SE BOISE STREET, #A, PORTLAND, OR 97206
(971) 359-3276
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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