Individual
TRICIA C PORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2524 HANNAH AVE NW, BEMIDJI, MN 56601-2110
(218) 210-0202
Mailing address
2524 HANNAH AVE NW, BEMIDJI, MN 56601-2110
(218) 210-0202
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2526923
MN
164W00000X
Licensed Practical Nurse
818680
MN
Other
Enumeration date
02/24/2022
Last updated
09/03/2024
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