Individual
THEA PORTENIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1803 WILSON ST, WASHINGTON, KS 66968
(785) 541-0385
Mailing address
1803 WILSON ST, WASHINGTON, KS 66968-8704
(785) 325-2787
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100394380B
—
KS
Enumeration date
11/01/2010
Last updated
04/08/2011
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