MEDICARE: MADALENNE PORTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	UV873715	OH

General Provider Information

NPI Number	:	1437999695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADALENNE PORTER

Provider Business Mailing Address
First Line	:	10877 READING RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45241-2553
Country	:	US
Telephone Number	:	513-885-2368
Fax Number	:

Provider Business Practice Location Address
First Line	:	10877 READING RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45241-2553
Country	:	US
Telephone Number	:	513-885-2368
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2024
Last Update Date	:	05/27/2024

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Directions to “ MADALENNE PORTER ” Practice Location

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