Provider Demographics
NPI:1568284669
Name:PORTER, ANDREA LYNNE (MSN, RN, CWON)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LYNNE
Last Name:PORTER
Suffix:
Gender:F
Credentials:MSN, RN, CWON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:4265 AUGUSTA PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-5613
Mailing Address - Country:US
Mailing Address - Phone:308-440-2357
Mailing Address - Fax:
Practice Address - Street 1:2201 N BROADWELL AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-2153
Practice Address - Country:US
Practice Address - Phone:308-395-3298
Practice Address - Fax:308-395-3289
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE64046163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse