1356720890 NPI number — MS. DEANNA GAIL PORTER 28427-31

Table of content: MS. DEANNA GAIL PORTER 28427-31 (NPI 1356720890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356720890 NPI number — MS. DEANNA GAIL PORTER 28427-31

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORTER
Provider First Name:
DEANNA
Provider Middle Name:
GAIL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
28427-31
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356720890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1706 S THOMPSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53716-1982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-228-7902
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1706 S THOMPSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53716-1982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-228-7902
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  28427-31 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F-11259 . This is a "PRIVATE DUTY NURSING FOR MEMBERS VENTILATOR DEPENDENT FOR LIFE-SUPPORT PEDIATRIC" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: F-11258 . This is a "PRIVATE DUTY NURSING FOR MEMBERS VENTILATOR DEPENDENT FOR LIFE-SUPPORT ADULT" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".