Individual
JASON EDWARD PORTELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
7245 RAIDER RD STE C, BONNE TERRE, MO 63628-3767
(573) 358-4600
(573) 358-4654
Mailing address
7245 RAIDER RD STE C, BONNE TERRE, MO 63628-3767
(573) 358-4600
(573) 358-4654
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2016044204
MO
Other
Enumeration date
12/23/2016
Last updated
08/11/2023
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