Individual
GRETCHEN EVANNE PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, CNP, LAC
Contact information
Practice address
5208 BLOOMINGTON AVE, MINNEAPOLIS, MN 55417-1820
(612) 916-0774
Mailing address
5208 BLOOMINGTON AVE, MINNEAPOLIS, MN 55417-1820
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
1305
MN
363LA2200X
Adult Health Nurse Practitioner
Primary
R0713753
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4927427-00
—
MN
Enumeration date
08/10/2006
Last updated
05/20/2008
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