MEDICARE: CASSANDRA E PORTER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	NP11954	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497056428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA E PORTER NP

Provider Business Mailing Address
First Line	:	4634 HILLS AND DALES RD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-1510
Country	:	US
Telephone Number	:	330-477-0255
Fax Number	:	330-479-0392

Provider Business Practice Location Address
First Line	:	4634 HILLS AND DALES RD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-1510
Country	:	US
Telephone Number	:	330-493-1480
Fax Number	:	330-493-6805

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2010
Last Update Date	:	02/28/2018

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