Provider Demographics
NPI:1699553008
Name:PORTER, ROSEAN M
Entity type:Individual
Prefix:MS
First Name:ROSEAN
Middle Name:M
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11309 CLOVER KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7375
Mailing Address - Country:US
Mailing Address - Phone:504-813-5587
Mailing Address - Fax:
Practice Address - Street 1:6940 CURRAN BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126
Practice Address - Country:US
Practice Address - Phone:504-812-6390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)