Healthcare Provider Details

I. General information

NPI: 1457278863
Provider Name (Legal Business Name): MINDI PORTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13644 W RIVER RD
COLUMBIA STATION OH
44028-9448
US

IV. Provider business mailing address

27030 OSBORNE RD
COLUMBIA STATION OH
44028-9572
US

V. Phone/Fax

Practice location:
  • Phone: 440-236-5020
  • Fax:
Mailing address:
  • Phone: 216-287-4905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number101891
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: