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NPI Code Detail

MEDICARE: NICHOLAS LEFENS PORTER PA-C

MEDICARE: NICHOLAS LEFENS PORTER PA-C
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
1363A00000XPhysician Assistant6576AZ

General Provider Information

NPI Number : 1578005682
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS LEFENS PORTER PA-C
Provider Business Mailing Address
First Line : 2732 N ALVERNON WAY
Second Line :
City : TUCSON
State : AZ
Zip : 85712-1804
Country : US
Telephone Number : 520-382-3330
Fax Number :
Provider Business Practice Location Address
First Line : 2732 N ALVERNON WAY
Second Line :
City : TUCSON
State : AZ
Zip : 85712-1804
Country : US
Telephone Number : 520-382-3330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2016
Last Update Date : 10/05/2021

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Directions to “ NICHOLAS LEFENS PORTER PA-C” Practice Location

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