Individual
ANGEL NICOLE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 233-7750
Mailing address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041530530
IL
Other
Enumeration date
03/09/2026
Last updated
03/09/2026
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