Healthcare Provider Details

I. General information

NPI: 1730154501
Provider Name (Legal Business Name): JANICE PORTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2148 W MERCURY BLVD
HAMPTON VA
23666-3111
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD SUITE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-1940
  • Fax: 757-896-4715
Mailing address:
  • Phone: 757-594-4006
  • Fax: 757-594-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024000083
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: