Healthcare Provider Details

I. General information

NPI: 1801852090
Provider Name (Legal Business Name): CHRIS L PORTER ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16259 SYLVESTER ROAD SW SUITE 404
BURIEN WA
98166
US

IV. Provider business mailing address

PO BOX 13684
SEATTLE WA
98198-1010
US

V. Phone/Fax

Practice location:
  • Phone: 206-241-1818
  • Fax: 206-244-3991
Mailing address:
  • Phone: 206-592-5000
  • Fax: 206-824-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30006421
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: