Provider Demographics
NPI:1962877662
Name:PORTO, FALISHA (CNP)
Entity type:Individual
Prefix:
First Name:FALISHA
Middle Name:
Last Name:PORTO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 CANTON ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-1507
Mailing Address - Country:US
Mailing Address - Phone:781-510-9459
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:MASS GENERAL HOSPITAL WANG 460
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1507
Practice Address - Country:US
Practice Address - Phone:781-510-9459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA281011163W00000X
MARN281011363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN 281011Medicaid