Individual
MARIE MICHELLE PORTHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
4501 EMPIRE CT, FREDERICKSBURG, VA 22408-1949
(540) 891-1200
(540) 891-1225
Mailing address
4501 EMPIRE CT, FREDERICKSBURG, VA 22408-1949
(540) 891-1200
(540) 891-1225
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024079016
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7788614
—
VA
Enumeration date
06/28/2006
Last updated
10/28/2015
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