Individual
STACI PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 790-4029
Mailing address
23320 PARK PLACE DR, SOUTHFIELD, MI 48033-7115
(313) 790-4029
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704296884NSA230HZ
MI
Other
Enumeration date
11/27/2023
Last updated
11/27/2023
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