Provider Demographics
NPI:1902983935
Name:PORTER, STEPHANIE J (CNS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:PORTER
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16948
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28816-0948
Mailing Address - Country:US
Mailing Address - Phone:828-670-8403
Mailing Address - Fax:828-670-8404
Practice Address - Street 1:100 RIDGEFIELD CT
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2207
Practice Address - Country:US
Practice Address - Phone:828-670-8403
Practice Address - Fax:828-670-8404
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC113825364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2593177Medicare ID - Type Unspecified