Provider Demographics
NPI:1396238929
Name:PORTER, STEPHANIE R (NP)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:R
Last Name:PORTER
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:3180 WILLOW LN STE 216
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4941
Mailing Address - Country:US
Mailing Address - Phone:805-491-5992
Mailing Address - Fax:805-283-4377
Practice Address - Street 1:3180 WILLOW LN STE 216
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-4941
Practice Address - Country:US
Practice Address - Phone:805-491-5992
Practice Address - Fax:805-283-4377
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2025-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZAP220464363LF0000X
CANP95008743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily