Provider Demographics
NPI:1083862981
Name:PORTEUS, MINDY (LPN)
Entity Type:Individual
Prefix:MS
First Name:MINDY
Middle Name:
Last Name:PORTEUS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5586 PURDY RD
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-7905
Mailing Address - Country:US
Mailing Address - Phone:315-573-6853
Mailing Address - Fax:
Practice Address - Street 1:5586 PURDY RD
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-7905
Practice Address - Country:US
Practice Address - Phone:315-573-6853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270131-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse