Provider Demographics
NPI:1508319930
Name:PORTER, TRIXIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TRIXIE
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13666 STEELE CT
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-8748
Mailing Address - Country:US
Mailing Address - Phone:303-257-5312
Mailing Address - Fax:
Practice Address - Street 1:13666 STEELE CT
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-8748
Practice Address - Country:US
Practice Address - Phone:303-257-5312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1620133163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1620133OtherNURSING LICENSE