Healthcare Provider Details

I. General information

NPI: 1659771673
Provider Name (Legal Business Name): POROTHEA DENNIS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 W 3RD ST
DAYTON OH
45402-6714
US

IV. Provider business mailing address

1323 W 3RD ST
DAYTON OH
45402-6714
US

V. Phone/Fax

Practice location:
  • Phone: 937-228-3612
  • Fax:
Mailing address:
  • Phone: 937-228-3612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number295063
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: