Individual
DEWANDA PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3288 OBERLIN AVE # OH005, LORAIN, OH 44053-2752
(866) 389-2727
Mailing address
30791 DETROIT RD # OH005, WESTLAKE, OH 44145-1835
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
13796-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952651721
—
OH
Enumeration date
09/19/2012
Last updated
04/24/2018
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