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General NPI Number Information
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NPI Number | 1902585755
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Entity Type | Individual
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Provider Name | DANIELLE PORTER
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Gender | Female
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 3600 HARVEY ST
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City | CHEYENNE
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State | WY
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Zip | 82009-4595
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Country | US
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Telephone | 307-262-4460
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 HARVEY ST
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City | CHEYENNE
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State | WY
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Zip | 82009-4595
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Country | US
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Telephone | 307-262-4460
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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 | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | DEEA2A6F9D
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | L-315138
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License Number State | WY
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