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Individual

MS. MIRANDA MARIE PORTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
4760 N 22ND ST, MILWAUKEE, WI 53209-6335
(414) 460-8392
Mailing address
4760 N 22ND ST, MILWAUKEE, WI 53209-6335
(414) 460-8392

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary

Other

Enumeration date
08/13/2020
Last updated
08/13/2020
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