Healthcare Provider Details

I. General information

NPI: 1912966284
Provider Name (Legal Business Name): HEATHER ANDREWS PORTO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER ANDREWS LENTZ CNM

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE SUITE 902
ALEXANDRIA VA
22304-1313
US

IV. Provider business mailing address

4660 KENMORE AVE SUITE 902
ALEXANDRIA VA
22304-1313
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-4300
  • Fax: 703-370-0044
Mailing address:
  • Phone: 703-370-4300
  • Fax: 703-370-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberARNP9239203
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0024167180
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: