Provider Demographics
NPI:1528567146
Name:PORTERFIELD, GERALDINE
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:PORTERFIELD
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:PO BOX 250131
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-0131
Mailing Address - Country:US
Mailing Address - Phone:248-631-8517
Mailing Address - Fax:
Practice Address - Street 1:2540 WOODROW WILSON BLVD APT 8
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-1723
Practice Address - Country:US
Practice Address - Phone:248-631-8517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No253Z00000XAgenciesIn Home Supportive Care
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health