Individual
MAKAYLA MARIE PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
222 TUCKERMAN RD, ASHBURNHAM, MA 01430-3051
(978) 514-2429
Mailing address
222 TUCKERMAN RD, ASHBURNHAM, MA 01430-3051
(978) 514-2429
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1162745
CT
363A00000X
Physician Assistant
Primary
1162745
—
Other
Enumeration date
06/03/2020
Last updated
06/03/2020
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