MEDICARE: YVETTE 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	163W00000X	Registered Nurse	642129	NY

General Provider Information

NPI Number	:	1598058265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVETTE PORTER

Provider Business Mailing Address
First Line	:	1258 NEW YORK AVE APT PA
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-5508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1258 NEW YORK AVE APT PA
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-5508
Country	:	US
Telephone Number	:	718-675-6215
Fax Number	:

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

Provider Enumeration Date	:	05/27/2011
Last Update Date	:	05/27/2011

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Directions to “ YVETTE PORTER ” Practice Location

Language	Start Address	Practice Location

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