Individual
JENNA N PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3535 W 13 MILE RD STE 248, ROYAL OAK, MI 48073-6770
(248) 551-1515
(248) 551-1516
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007531
MI
Other
Enumeration date
01/26/2016
Last updated
09/25/2024
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