Individual
STACEY R. PORTERFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1201 TUCKAWAY LN, MENASHA, WI 54952-1704
(920) 733-4443
(920) 733-4796
Mailing address
1201 TUCKAWAY LN, MENASHA, WI 54952-1704
(920) 733-4443
(920) 733-4796
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
308986
WI
Other
Enumeration date
09/22/2008
Last updated
09/22/2008
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