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Individual

OCTAVIA PORTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
4080 E LAKE MEAD BLVD STE B111, LAS VEGAS, NV 89115-6466
(702) 531-9344
Mailing address
4080 E LAKE MEAD BLVD STE B111, LAS VEGAS, NV 89115-6466
(702) 531-9344

Taxonomy

Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7022105462
NV
Enumeration date
09/13/2022
Last updated
09/13/2022
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