Individual
BONNIE D PORTER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
15TH AT PERSHING, LIBERAL, KS 67901-2455
(620) 624-1651
(620) 629-6655
Mailing address
2501 LILAC DR, LIBERAL, KS 67901-4945
(620) 624-4796
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
54986
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
144662
BLUE CROSS
KS
Enumeration date
06/16/2006
Last updated
07/08/2007
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