Provider Demographics
NPI:1215918289
Name:PORTER, BRANDIE L (APRN, CNM, FNP)
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:L
Last Name:PORTER
Suffix:
Gender:F
Credentials:APRN, CNM, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SWANZEY
Mailing Address - State:NH
Mailing Address - Zip Code:03446-3012
Mailing Address - Country:US
Mailing Address - Phone:317-809-2391
Mailing Address - Fax:888-892-4686
Practice Address - Street 1:12 MAIN ST
Practice Address - Street 2:
Practice Address - City:SWANZEY
Practice Address - State:NH
Practice Address - Zip Code:03446-3012
Practice Address - Country:US
Practice Address - Phone:317-809-2391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH048205-23367A00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3099804Medicaid
IN200335640Medicaid
VT1024318Medicaid