Healthcare Provider Details

I. General information

NPI: 1881267474
Provider Name (Legal Business Name): RACHAEL PORTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BIRCH ST STE 204
MILFORD MA
01757-3585
US

IV. Provider business mailing address

4361 E EDISON ST
TUCSON AZ
85712-3238
US

V. Phone/Fax

Practice location:
  • Phone: 508-568-9335
  • Fax:
Mailing address:
  • Phone: 508-498-0451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number266688
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2380610
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN160001
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: