Individual
JENNIFER PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
490A W ZIA RD, SANTA FE, NM 87505-6996
(505) 913-8900
(505) 913-8923
Mailing address
490A W ZIA RD, SANTA FE, NM 87505-6996
(505) 913-8900
(505) 913-8923
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CNP-01564
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200880420
—
IN
Enumeration date
10/09/2007
Last updated
06/02/2015
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