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General NPI Number Information
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NPI Number | 1831653302
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Entity Type | Individual
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Provider Name | DANIEL PORTICE PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 01/29/2019
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Last Update Date | 05/07/2026
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Provider Practice Location Address
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Address Line | 802 E GORHAM ST
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City | MADISON
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State | WI
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Zip | 53703-1524
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Country | US
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Telephone | 608-280-4713
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Fax | 608-280-4707
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Provider Business Mailing Address
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Address Line | 617 RIVERSIDE AVE
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City | BURLINGTON
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State | VT
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Zip | 05401-1601
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Country | US
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Telephone | 802-540-8288
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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 | 244422-30
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License Number State | WI
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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 | 101.0139266
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License Number State | VT
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