Healthcare Provider Details

I. General information

NPI: 1497624449
Provider Name (Legal Business Name): COURTNEY NICOLE PORTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

IV. Provider business mailing address

167 NORTHERN AVE
AUGUSTA ME
04330-4215
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-1000
  • Fax:
Mailing address:
  • Phone: 207-992-7384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN73176
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: