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General NPI Number Information
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NPI Number | 1437951217
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Entity Type | Individual
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Provider Name | EMILY AMANDA PORZONDEK INTERN
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Gender | Female
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 3111 ELECTRIC AVE
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City | PORT HURON
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State | MI
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Zip | 48060-8127
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Country | US
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Telephone | 810-985-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 50734 WOODBURY DR
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City | NEW BALTIMORE
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State | MI
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Zip | 48047-4391
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Country | US
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Telephone | 586-354-1711
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704362685
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License Number State | MI
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