Individual
NATASHA E PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7979 N SHADELAND AVE, STE 200, INDIANAPOLIS, IN 46250-2042
(317) 621-4300
(317) 621-4301
Mailing address
250 N SHADELAND AVE STE 200, INDIANAPOLIS, IN 46219-4959
(317) 962-4836
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10001011A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000656388
ANTHEM
IN
01
—
000000741054
ANTHEM
IN
01
—
P01157122
RR MEDICARE
IN
01
—
P01751324
RR MEDICARE
IN
Enumeration date
07/11/2008
Last updated
12/28/2020
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