Provider Demographics
NPI:1104504901
Name:PORCELLA, KIRSTEN S
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:S
Last Name:PORCELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W 115TH ST APT 95
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7710
Mailing Address - Country:US
Mailing Address - Phone:808-205-3056
Mailing Address - Fax:
Practice Address - Street 1:601 W 115TH ST APT 95
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7710
Practice Address - Country:US
Practice Address - Phone:808-205-3056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313893164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse