Provider Demographics
NPI:1225103823
Name:PORTER, ANGELA GAYLE
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:GAYLE
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:GAYLE
Other - Last Name:DINGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1122 BOREN BLVD
Mailing Address - Street 2:APT. E
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-9251
Mailing Address - Country:US
Mailing Address - Phone:740-357-2983
Mailing Address - Fax:
Practice Address - Street 1:1122 BOREN BLVD
Practice Address - Street 2:APT. E
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-9251
Practice Address - Country:US
Practice Address - Phone:740-357-2983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered372500000XNursing Service Related ProvidersChore Provider
Not Answered374U00000XNursing Service Related ProvidersHome Health Aide