Healthcare Provider Details

I. General information

NPI: 1841719077
Provider Name (Legal Business Name): JAMIE LEE PORTER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 70TH AVE STE 110
GREELEY CO
80634-4628
US

IV. Provider business mailing address

185 INDIAN PEAKS DR
ERIE CO
80516-2646
US

V. Phone/Fax

Practice location:
  • Phone: 970-810-4155
  • Fax:
Mailing address:
  • Phone: 763-913-7530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09170702
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: