Individual
MICHELLE PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
402 STAGECOACH DR, JACKSONVILLE, NC 28546-8663
(252) 646-0605
Mailing address
402 STAGECOACH DR, JACKSONVILLE, NC 28546-8663
(252) 646-0605
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
238119
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207VX0000X
—
NC
Enumeration date
02/10/2015
Last updated
02/10/2015
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