Individual
CLOIE DENITA PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2640 APPLEGATE RD, LUCAS, OH 44843-9718
(419) 892-2895
Mailing address
2640 APPLEGATE RD, LUCAS, OH 44843-9718
(419) 892-2895
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN. 111913
OH
164W00000X
Licensed Practical Nurse
PN.111913
OH
Other
Enumeration date
06/05/2008
Last updated
06/05/2008
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