Individual
STEPHANIE MAE PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
101 S MOORE AVE, CLAREMORE, OK 74017-5047
(918) 342-6495
Mailing address
101 S MOORE AVE, CLAREMORE, OK 74017-5047
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
102328
OK
163WC0200X
Critical Care Medicine Registered Nurse
102328
OK
163WE0003X
Emergency Registered Nurse
Primary
102328
OK
Other
Enumeration date
12/20/2018
Last updated
12/20/2018
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