Individual
SALLIE LYNN PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
701 GROVE RD, GREENVILLE, SC 29605-4210
(864) 455-7111
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6307
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
230383
NC
367500000X
Certified Registered Nurse Anesthetist
090067
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
20071
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN2555
—
SC
01
—
Q39503A
MEDICARE PTAN
NC
01
—
Q53045
MEDICARE PTAN
SC
Enumeration date
03/27/2012
Last updated
05/31/2016
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