Healthcare Provider Details

I. General information

NPI: 1366353211
Provider Name (Legal Business Name): DOROTHY JANE PORTER RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 1 BOX 8150
SELLS AZ
85634-9737
US

IV. Provider business mailing address

220 W MORONDO AVE
AJO AZ
85321-2419
US

V. Phone/Fax

Practice location:
  • Phone: 520-362-7007
  • Fax: 520-496-3283
Mailing address:
  • Phone: 520-362-7007
  • Fax: 520-496-3283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN082876
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: