Provider Demographics
NPI:1407114598
Name:PORTER, NDUBA
Entity Type:Individual
Prefix:
First Name:NDUBA
Middle Name:
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 1:14802 WAVERTON CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-4498
Mailing Address - Country:US
Mailing Address - Phone:281-948-4406
Mailing Address - Fax:281-498-6322
Practice Address - Street 1:14802 WAVERTON CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-4498
Practice Address - Country:US
Practice Address - Phone:281-948-4406
Practice Address - Fax:281-498-6322
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider