Provider Demographics
NPI:1285940734
Name:PORTER, NANCY (MD, MPH)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ALYSON
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:2400 WELLESLEY DR NE
Mailing Address - Street 2:NM DOH
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1812
Mailing Address - Country:US
Mailing Address - Phone:505-841-4100
Mailing Address - Fax:
Practice Address - Street 1:2400 WELLESLEY DR NE
Practice Address - Street 2:NM DOH
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1812
Practice Address - Country:US
Practice Address - Phone:505-841-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2458642083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine