Healthcare Provider Details

I. General information

NPI: 1194685891
Provider Name (Legal Business Name): DEANNA PORTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5633 RANCHO LA LOMA LINDA DR
PASO ROBLES CA
93446-7471
US

IV. Provider business mailing address

5633 RANCHO LA LOMA LINDA DR
PASO ROBLES CA
93446-7471
US

V. Phone/Fax

Practice location:
  • Phone: 805-610-9025
  • Fax:
Mailing address:
  • Phone: 805-610-9025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number729385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: