Provider Demographics
NPI:1538317599
Name:PORTER, NORMAN EUGENE II (LPN)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:EUGENE
Last Name:PORTER
Suffix:II
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SUNFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8910
Mailing Address - Country:US
Mailing Address - Phone:631-849-4009
Mailing Address - Fax:
Practice Address - Street 1:2 SUNFLOWER LN
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8910
Practice Address - Country:US
Practice Address - Phone:631-849-4009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175478-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse