Provider Demographics
NPI:1164280996
Name:PORTER, BRIANA NIREE
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:NIREE
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 1:315 SUNDIAL LN APT F
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-1966
Mailing Address - Country:US
Mailing Address - Phone:704-632-5356
Mailing Address - Fax:
Practice Address - Street 1:315 SUNDIAL LN APT F
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-1966
Practice Address - Country:US
Practice Address - Phone:704-632-5356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96072164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse