Provider Demographics
NPI:1275054926
Name:PORTER, ADRIAN K (RD,LD)
Entity Type:Individual
Prefix:MISS
First Name:ADRIAN
Middle Name:K
Last Name:PORTER
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 WYOGA LAKE RD APT 106
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44224-6823
Mailing Address - Country:US
Mailing Address - Phone:330-283-9140
Mailing Address - Fax:
Practice Address - Street 1:1 AKRON GENERAL AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2432
Practice Address - Country:US
Practice Address - Phone:330-344-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5940133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered