Healthcare Provider Details

I. General information

NPI: 1982417036
Provider Name (Legal Business Name): DEBORAH PORTA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 AMERICAS WAY # 13186
BOX ELDER SD
57719-7600
US

IV. Provider business mailing address

514 AMERICAS WAY # 13186
BOX ELDER SD
57719-7600
US

V. Phone/Fax

Practice location:
  • Phone: 612-501-0242
  • Fax:
Mailing address:
  • Phone: 612-501-0242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11493829-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License NumberR054165
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: