Healthcare Provider Details

I. General information

NPI: 1720084932
Provider Name (Legal Business Name): NANCY M PORTNER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 W STATE ST
DOYLESTOWN PA
18901-2597
US

IV. Provider business mailing address

700 LAWN AVE
SELLERSVILLE PA
18960-1548
US

V. Phone/Fax

Practice location:
  • Phone: 215-345-2200
  • Fax:
Mailing address:
  • Phone: 215-453-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-288493-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: