Healthcare Provider Details

I. General information

NPI: 1760393805
Provider Name (Legal Business Name): AUBRIE PORTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

1104 7TH AVE S
MOORHEAD MN
56563-0001
US

IV. Provider business mailing address

3472 4TH AVE E APT 101
DICKINSON ND
58601-5075
US

V. Phone/Fax

Practice location:
  • Phone: 320-815-4753
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: