Provider Demographics
NPI:1225876592
Name:PORTER, CLORISSA HOPE (LPN)
Entity type:Individual
Prefix:
First Name:CLORISSA
Middle Name:HOPE
Last Name:PORTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 US ROUTE 60 W
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-1112
Mailing Address - Country:US
Mailing Address - Phone:304-743-8160
Mailing Address - Fax:
Practice Address - Street 1:1707 US ROUTE 60 W
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541-1112
Practice Address - Country:US
Practice Address - Phone:304-743-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV40961164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse