Individual
PEGGY J PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
81-6587 MAMALAHOA HWY, C 201, KEALAKEKUA, HI 96750
(808) 323-3107
(808) 323-0012
Mailing address
816587 MAMALAHOA HWY, KEALAKEKUA, HI 96750
(808) 323-3107
(808) 323-0012
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
440373
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150022505
—
TX
05
—
150022506
—
TX
05
—
150022507
—
TX
Enumeration date
02/23/2007
Last updated
08/30/2016
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