Individual
CAROLYN MARIE PORTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, MPH, RN, SANE-A
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2595
(651) 226-4221
Mailing address
1930 PINEHURST AVE, SAINT PAUL, MN 55116-1339
(651) 226-4221
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R-12972-2
MN
Other
Enumeration date
11/04/2024
Last updated
11/04/2024
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