Individual
BASHEBA LAWONDA PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
4370 W MAIN ST, DOTHAN, AL 36305-1056
(334) 793-5000
Mailing address
4370 W MAIN ST, DOTHAN, AL 36305-1056
(334) 793-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
1-126649
AL
363LF0000X
Family Nurse Practitioner
Primary
1-126649
AL
Other
Enumeration date
06/02/2023
Last updated
09/11/2023
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