MEDICARE: EMILY PORTER IDMT

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	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1720409675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY PORTER IDMT

Provider Business Mailing Address
First Line	:	PCS 17 BOX 66
Second Line	:
City	:	APO
State	:	AE
Zip	:	09214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 17 BOX 66
Second Line	:
City	:	APO
State	:	AE
Zip	:	09214-0001
Country	:	US
Telephone Number	:	175-559-7566
Fax Number	:

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

Provider Enumeration Date	:	12/19/2013
Last Update Date	:	03/25/2015

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Directions to “ EMILY PORTER IDMT” Practice Location

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