Individual
MRS. CATHERINE J PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
463 DEERFIELD LN, CARBONDALE, IL 62902-8076
(618) 201-2240
Mailing address
463 DEERFIELD LN, CARBONDALE, IL 62902-8076
(618) 351-6619
(618) 351-6619
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
041308103
IL
163WG0000X
General Practice Registered Nurse
067173
MO
163WG0000X
General Practice Registered Nurse
RN00108404
WA
367500000X
Certified Registered Nurse Anesthetist
067173
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
209000368
IL
Other
Enumeration date
10/10/2006
Last updated
10/08/2018
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