Provider Demographics
NPI:1114361383
Name:PORTER, MARCIA DIANNE (RN)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:DIANNE
Last Name:PORTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50224 UPTOWN AVE
Mailing Address - Street 2:UNIT 202
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4469
Mailing Address - Country:US
Mailing Address - Phone:734-657-2571
Mailing Address - Fax:
Practice Address - Street 1:2140 E ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2552
Practice Address - Country:US
Practice Address - Phone:734-222-3500
Practice Address - Fax:734-971-2487
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704287781163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse