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General NPI Number Information
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NPI Number | 1649703349
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Entity Type | Individual
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Provider Name | MISS ERICA PORTER
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Gender | Female
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 4760 E 68TH ST #267
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City | TULSA
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State | OK
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Zip | 74136
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Country | US
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Telephone | 918-565-2710
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Fax |
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Provider Business Mailing Address
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Address Line | 4760 E 68TH ST APT267
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City | TULSA
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State | OK
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Zip | 74136-4942
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Country | US
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Telephone | 918-565-2710
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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 | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | D999730843
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License Number State | OK
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