Individual
SAMANTHA JO PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
820 4TH ST N, FARGO, ND 58102-4539
(701) 234-6161
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
12535589-4405
UT
Other
Enumeration date
07/21/2014
Last updated
02/20/2024
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