Provider Demographics
NPI:1497115901
Name:PORTER, JENNIE LYNNE (ND)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:LYNNE
Last Name:PORTER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1723
Mailing Address - Country:US
Mailing Address - Phone:801-784-4190
Mailing Address - Fax:801-825-2134
Practice Address - Street 1:560 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1723
Practice Address - Country:US
Practice Address - Phone:801-784-4190
Practice Address - Fax:801-825-2134
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath