Provider Demographics
NPI:1265689954
Name:COLE, PORTIA MASON (OB-GYN NP)
Entity Type:Individual
Prefix:MRS
First Name:PORTIA
Middle Name:MASON
Last Name:COLE
Suffix:
Gender:F
Credentials:OB-GYN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-4401
Mailing Address - Country:US
Mailing Address - Phone:910-433-3600
Mailing Address - Fax:
Practice Address - Street 1:1235 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4401
Practice Address - Country:US
Practice Address - Phone:910-433-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC58970363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCZF0000031Medicaid