Individual
SHAILECE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
104 SOUTH COSTELLO STREET, WALTHILL, NE 68067
(402) 846-5533
Mailing address
104 SOUTH COSTELLO STREET, WALTHILL, NE 68067
(402) 846-5533
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
H13858305
NE
Other
Enumeration date
11/12/2021
Last updated
11/29/2021
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