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General NPI Number Information
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NPI Number | 1396238929
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Entity Type | Individual
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Provider Name | STEPHANIE R PORTER NP
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Gender | Female
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Dates
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Enumeration Date | 06/08/2018
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 3180 WILLOW LN STE 216
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-4941
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Country | US
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Telephone | 805-491-5992
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Fax | 805-283-4377
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Provider Business Mailing Address
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Address Line | 3180 WILLOW LN STE 216
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-4941
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Country | US
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Telephone | 805-491-5992
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Fax | 805-283-4377
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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 | AP220464
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95008743
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License Number State | CA
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