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General NPI Number Information
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NPI Number | 1013739895
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Entity Type | Individual
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Provider Name | JENAE B. PORTER BSN, RN
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Gender | Female
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 1201 100TH ST NE
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City | GRANITE FALLS
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State | WA
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Zip | 98252-8632
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Country | US
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Telephone | 360-691-7718
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Fax | 425-412-8493
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Provider Business Mailing Address
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Address Line | 205 N ALDER AVE
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City | GRANITE FALLS
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State | WA
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Zip | 98252-8907
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Country | US
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Telephone | 360-691-7717
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Fax | 425-412-8493
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | RN61521018
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License Number State | WA
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