Individual
TIFFANY ETTA PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
68377 STEWART DR STE 202, SAINT CLAIRSVILLE, OH 43950-1718
(740) 699-2747
Mailing address
90 N 4TH ST, MARTINS FERRY, OH 43935-1648
(740) 633-1100
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
06655
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2603432000
—
WV
01
—
H207804
MEDICARE PTAN
OH
Enumeration date
10/19/2006
Last updated
12/11/2020
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