Individual
ASHLEY MICHELLE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(919) 784-3100
Mailing address
3100 SPRING FOREST RD, SUITE 130, RALEIGH, NC 27616-2880
(919) 873-9533
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
73611
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
93288
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1366861668
TRICARE
NC
05
—
1366861668
—
NC
01
—
1878M
BCBS
NC
Enumeration date
04/15/2014
Last updated
10/23/2014
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