Individual
DESIREE PORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
320 N 5TH ST, BEATRICE, NE 68310-2957
(402) 223-1500
Mailing address
1320 LINCOLN ST, BEATRICE, NE 68310-3166
(402) 251-4176
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27486
NE
Other
Enumeration date
01/25/2023
Last updated
01/25/2023
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