Provider Demographics
NPI:1407238413
Name:PORTER-SAKUMURA, JENNIFER BETH (RN,, IBCLC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BETH
Last Name:PORTER-SAKUMURA
Suffix:
Gender:F
Credentials:RN,, IBCLC
Other - Prefix:
Other - First Name:J
Other - Middle Name:BETH
Other - Last Name:PORTER-SAKUMURA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, IBCLC
Mailing Address - Street 1:3221 SE MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:KS
Mailing Address - Zip Code:66542-9599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3221 SE MAGNOLIA LN
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:KS
Practice Address - Zip Code:66542-9599
Practice Address - Country:US
Practice Address - Phone:785-550-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-98271-052163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant