Individual
MRS. JEANETTE MARIE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
540 LAFAYETTE RD, SUITE D, SPARTA, NJ 07871-3497
(973) 300-1553
(973) 383-6236
Mailing address
540 LAFAYETTE RD, SUITE D, SPARTA, NJ 07871-3497
(973) 300-1553
(973) 383-6236
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3500
AZ
363AS0400X
Surgical Physician Assistant
Primary
25MP00223600
NJ
363AS0400X
Surgical Physician Assistant
3500
AZ
Other
Enumeration date
10/11/2006
Last updated
10/01/2009
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