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General NPI Number Information
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NPI Number | 1023622149
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Entity Type | Individual
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Provider Name | STEPHANIE LANE PORTER FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 3721 S AMHERST HWY
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City | MADISON HEIGHTS
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State | VA
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Zip | 24572-5985
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Country | US
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Telephone | 434-202-4318
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Fax | 434-300-5562
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Provider Business Mailing Address
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Address Line | PO BOX 1187
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City | MADISON HEIGHTS
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State | VA
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Zip | 24572-1187
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Country | US
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Telephone | 434-202-4318
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Fax | 434-300-5562
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024179655
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024179655
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License Number State | VA
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